What is the role of neurosurgery in the treatment of trigeminal neuralgia (TN)?

Updated: Sep 30, 2019
  • Author: Kim J Burchiel, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Neurosurgery is generally more helpful in those patients with paroxysmal rather than constant pain and in patients whose pain follows the anatomic distribution of 1 or more trigeminal distributions rather than being spread diffusely. The various operations often fail after 1 or several years of initial relief. Such failure necessitates a repeat procedure, often with improved but still incomplete results. Thus, many patients eventually restart pain medication after surgery. Surgery appears to be less effective for TN secondary to multiple sclerosis (MS).

The timing for surgery is debatable, and no randomized study has addressed this question. However, it seems that the earlier a surgical technique is applied, the better the outcome is likely to be. At least 2 medication trials should be performed and carefully evaluated before more invasive techniques are instituted. [2]

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