From the Guidelines
Trigeminal neuralgia surgery is primarily performed by neurosurgeons, with some procedures also being performed by specialized otolaryngologists with advanced training in skull base surgery. When considering surgical intervention for trigeminal neuralgia, it is crucial to consult with a neurosurgeon at an early stage, as they specialize in treating conditions affecting the brain and nervous system 1. The decision to undergo surgery is typically made when medication management, such as carbamazepine or oxcarbazepine, has proven ineffective or caused intolerable side effects 1. Some key points to consider when evaluating surgical options for trigeminal neuralgia include:
- The most common surgical procedures for trigeminal neuralgia are microvascular decompression and various ablative procedures such as radiofrequency ablation, glycerol rhizotomy, or balloon compression 1
- Microvascular decompression is a major neurosurgical procedure that can provide a 70% chance of being pain-free at 10 years, but it also carries risks such as hearing loss and mortality 1
- Ablative procedures can result in varying degrees of sensory loss, and the choice of surgical approach depends on the patient's age, overall health, specific symptoms, and whether previous treatments have failed 1
- Patients should seek out surgeons who regularly perform these specialized procedures, as experience significantly impacts outcomes.
From the Research
Trigeminal Neuralgia Surgery Performers
- Neurosurgeons perform trigeminal neuralgia surgery, as the condition often requires neurosurgical intervention to relieve pain and eliminate unpleasant side effects of medication 2.
- The two major neurosurgical choices for trigeminal neuralgia are percutaneous denervation and microvascular decompression (MVD), with MVD being the surgical treatment of choice for many patients 3.
Surgical Procedures
- Percutaneous denervation is a less invasive procedure that is often recommended for patients with multiple sclerosis, medical illness, or elderly patients 2.
- Microvascular decompression (MVD) is a more invasive procedure that aims to separate the culprit vessel from the trigeminal nerve, and is often performed by neurosurgeons with expertise in this area 3, 4.
- Other surgical procedures, such as partial sensory rhizotomy or internal neurolysis, may be performed in addition to MVD to improve surgical outcomes 3, 5.
Specializations
- Neurosurgeons who specialize in trigeminal neuralgia surgery often have expertise in MVD and other surgical procedures, and may work in hospitals or clinics that specialize in neurosurgery 6, 5.
- Some neurosurgeons may also have expertise in stereotactic radiosurgery, which is a non-invasive procedure that uses radiation to treat trigeminal neuralgia 6, 5.