Table 6

Surgical management of trigeminal neuralgia

Type of surgeryProcedureMortalityMorbidity , recurrence rates
Peripheral therapies: cryotherapy, neurectomy, alcohol injectionsThe peripheral nerve branch is either directly exposed or injected under local anaesthesiaNilLow and local, mainly mild sensory loss. Recurrence rate mean 10 months
Gasserian ganglionShort acting general anaesthesia used to penetrate foramen ovaleAll result in varying degrees of sensory loss, which can lead to eye problems, temporary motor weakness
Radiofrequency thermocoagulationThe Gasserian ganglion is subjected to temperature varying from 60–80°CLowHighest risk of anaesthesia dolorosa. Recurrence rate at 5 years 60%
Glycerol injectionMeckel’s cave is filled with glycerolVery lowLess likely to cause eye problems or anaesthesia dolorosa. Recurrence rate at 5 years 65%
MicrocompressionThe Gasserian ganglion is compressed by a balloon for a few secondsVery lowPeroperative hypotensive episodes. Recurrence rate at 2 years 20%
Posterior fossaFull general anaesthesia used7th and 8th cranial nerves may be affected
Microvascular decompressionAny vessels lying on the trigeminal nerve at the point of entry to the cranium are moved aside or removedUp to 0.4 %Minimal effects on sensory loss or eye problems, surgeon dependent. Recurrence rates at 5 years 25%
Gamma knifeUsing stereotactic techniques the posterior fossa is identified and 75 G beam directed at the trigeminal nerveUnknown at presentLong term effects of radiation unknown, takes up to 6 months for an effect. Recurrence rate at 2 years 25%