The decision to opt for surgery is based on response to, and side effects from, medical treatment, the patient's age, and the surgical facilities and expertise available. The candidate must be in a physical condition that will allow safe general anesthesia and neurosurgery. Patients should be given concise and clear explanations of the potential surgical complications and the alternative neurosurgical procedures.
Surgery may be aimed peripherally at the affected branch or centrally at the trigeminal ganglion or the nerve root. Any surgical procedure seems to have a better prognosis when carried out as a first procedure particularly on patients with purely paroxysmal CTN; in MVD, best effects are obtained when performed within 7 years of CTN onset. The changing trend in neurosurgical options in the United States was studied in a 20-year retrospective analysis. The use of MVD has nearly doubled from 1988 to 2008, while rhizotomy interventions have dropped to about a tenth of the numbers being performed previously. Radiosurgery, introduced in the early 1990s, peaked in 2004 but has since declined. For ethical reasons, there are no sham-controlled neurosurgical studies and only a few quality trials on neurosurgical procedures for TN, particularly comparative studies that may aid in making individual choices.
Headache. 2021;61(6):817-837. © 2021 Blackwell Publishing