When is trigeminal neuralgia (TN) surgery indicated?

Updated: Sep 30, 2019
  • Author: Kim J Burchiel, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Surgical treatment is indicated for patients whose TN is intractable despite medical therapy, in those who are intolerant to the adverse effects of the medications, and in those in whom previous procedures failed.

MVD is usually indicated for patients younger than 70 years who are at lower risk for complications during general anesthesia, although healthy older patients can tolerate it well. Percutaneous approaches (eg, radiofrequency ablation, glycerol injection, balloon compression, radiosurgery) are more frequently offered to elderly patients, those in poor medical condition, those with MS, and those in whom previous MVD has failed.

In elderly patients with limited life expectancy, radiofrequency rhizotomy (ie, PRTG) is sometimes preferred because it is easy to perform, has few complications, and provides symptomatic relief for a period.

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