Percutaneous treatment of trigeminal neuralgia: A narrative review

Abstract

Background: Minimally invasive and percutaneous treatments are effective treatment options for idiopathic trigeminal neuralgia (TN).Objectives: Multiple approaches have been described for the treatment of TN. This narrative review has been done to evaluate the current literature on different percutaneous treatment options for TN and to determine whether anyone treatment is better. Methods: The literature through a search of PubMed and Google Scholar was done and the review of the citations of relevant literature, and the authors knowledge of the literature and activity in the field. The literature was reviewed to find the preferred technique of preferred percutaneous treatment by different investigators and the difference in the outcome and/or complications and side effects. Results: Multiple techniques of such as percutaneous retrogasserian glycerol rhizolysis (PRGR), radiofrequency thermal coagulation (RFTC), and percutaneous balloon compression (PBC) for idiopathic TN have been used by different researchers. Effective pain relief and improved quality of life have been reported to be achieved by all the approaches. RFTC has been the most extensively used method, but PBC has been found to be more suitable for corneal preservation in cases of ophthalmic (V1) division pain. The most common imaging method used by large number of researchers is fluoroscope, though few authors have recommended computed tomography scan guidance for placement of cannula in foramen ovale and Meckle's cave, especially in cases with difficult anatomy. Limitations: This review has focused only on percutaneous techniques used by pain physicians. Other techniques such as radiosurgery and gamma knife used by radiologists and neurologists are not included. Conclusions: minimally invasive and percutaneous treatments such as PRGR, RFTC, and PBC are effective methods for the treatment of idiopathic TN. Selection of approach is largely dependent on the pain physician's choice, experience, and equipment available and can be used interchangeably; although for V1 neuralgia, PBC has superiority due to the preservation of corneal reflex.