What are the possible complications of trigeminal neuralgia (TN) surgery?

Updated: Sep 30, 2019
  • Author: Kim J Burchiel, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Morbidity associated with trigeminal nerve decompression stems from hemorrhage, infection, and possible damage to the brainstem around the area of decompression. Adverse effects of surgery include corneal anesthesia, facial numbness outside of the trigger zone, new facial pain, facial dysesthesias, and intracranial hemorrhage (rare). Anesthesia dolorosa (TN pain associated with dense hypesthesia) is usually a result of surgical treatment; this is difficult to treat.

In centers where MVD is frequently performed, complications include facial dysesthesia (0.3%), facial numbness (0.15%), cerebellar injuries and hearing loss (< 1%), and CSF leakage (< 2%).

Complications of PRTG depend on the amount of numbness created by the lesion. Dysesthesia has been reported in up to 5-25% of patients, corneal numbness in up to 15%, and masseter weakness in about 4%. These complications are markedly reduced if the numbness produced by the procedure is limited. Some of these complications may be reversible. To avoid ophthalmic complications, some experts do not recommend this approach when the ophthalmic division is involved. [28]

The rate of pain recurrence with PRGR is between that of radiofrequency ablation and that of percutaneous compression. The rate of significant facial numbness (5%) is low. About half of the patients have pain recurrence at 2 years. [29] PBM carries about the same complications and average pain-free outcome as PRGR does (2 y). [30, 31]

The average pain-free outcome of GKS is somewhat less than that of PRTG, or around 3 years. [18, 32]

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