THE CHOICE OF THERAPY IN MEDICALLY INTRACTABLE TRIGEMINAL NEURALGIA

Trigeminal neuralgia stands out as one of the few severe neuropathic p ain states for which successful treatment options are available. Up to one-half of patients become refractory to medical therapy over time. At this point, the question of which intervention is appropriate becom es an important issue. A personal series of 150 patients treated betwe en 1988 and 1995 is reviewed. Patients under 65 years and in good gene ral health underwent surgery for microvascular decompression of the tr igeminal root; in the remaining 120 patients glycerol. was injected pe rcutaneously into the trigeminal cistern. The results in these two pat ient groups is presented and the rationale of choosing an operative ve rsus a percutaneous procedure is discussed in light of the outcome in this series and in the literature.