Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia |
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Authors: | Guido Orlandini |
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Institution: | (1) Pain Therapy and Palliative Care Center, Hospital of Tortona, Tortona (AL), Italy, e-mail: orlandiniguido@asl20.piemonte.it, Tel.: +39-0131-865361, Fax: +39-0131-865403, IT |
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Abstract: | The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure
of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established
place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients beause
of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux.
Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple
arterial loop and neurovascular contract. Probably, many immediate failures and early relapses are the consequence of the
inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate
selection can be explained by the difficult preoperative diagnosis of NVC in the past. Indeed, angiography and computed tomography
showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable
instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with
the following: (1) percutaenous techniques are indicated for patients without demonstrated NVC (including patients with TN
in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and
(2) MVD is incated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor
this operation desiring no sensory deficit.
Received: 23 June 2001 / Accepted in revised form: 24 August 2001 |
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Keywords: | Trigeminal neuralgia Neurovascular conflict Trigeminal percutaneous radiofrequency thermorhizotomy Microvascular decompression |
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