title: Options in treating trigeminal neuralgia: Experience with 195 patients.
abstract: OBJECTIVE
  For patients with medically unresponsive trigeminal neuralgia (TN), surgical options include microvascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radiosurgery (SRS). In an attempt to identify the risks and benefits and cost inherent with each of the three modalities, we performed a retrospective review of our experience with 195 cases of TN treated over the past 15 years.
  
  
  METHODS
  Since 2001, 195 patients with previously untreated TN were managed: with MVD in 79, RF in 36, and SRS in 80. All patients reported herein underwent preoperative MRI. Women outnumbered men 122/73 (p=0.045). Follow-up after surgery was 32±46months.
  
  
  RESULTS
  The patients qualifying for MVD were generally healthier and younger, with a mean age±SD of 57±14, compared to those undergoing RF (75±15) or SRS (73±13, p<0.0001). In case of relapse, medical treatment was always tried and failed prior to consideration of surgical intervention. A second surgical procedure was necessary in 2, 23, and 18 patients initially treated with MVD, RF, and SRS respectively (p<0.0001). In the patients treated with MVD, RF, and SRS, the average number of procedures per patient necessary to achieve pain control was 1.1, 2.0, and 1.3 respectively (p=0.001). There were 7 complications in the patients treated with MVD but no deaths. Numbness was present in 13, 18, and 29 patients treated with MVD, RF, and SRS respectively (p=0.008).
  
  
  CONCLUSIONS
  MVD for TN is the treatment least likely to fail or require additional treatment. Patients who underwent MVD were younger than those undergoing RF or SRS. The highest rate of recurrence of TN was encountered in patients undergoing RF (64%). Facial numbness was least likely to occur with MVD (16%) compared to RF and SRS (50% and 36% respectively).
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States. Electronic address: patrick-hitchon@uiowa.edu.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hitchon
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
authors.forename: Marshall
authors.initials: M
authors.lastname: Holland
authors.affiliation: Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Noeller
authors.affiliation: Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Smith
authors.affiliation: Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
authors.forename: Toshio
authors.initials: T
authors.lastname: Moritani
authors.affiliation: Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States.
authors.forename: Nivedita
authors.initials: N
authors.lastname: Jerath
authors.affiliation: Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ, United States.
authors.forename: Wenzhuan
authors.initials: W
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019051:Rhizotomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D014277:Trigeminal Neuralgia / Q000601:surgery*
keywords: Microvascular decompression; Radiofrequency rhizotomy; Stereotactic radiosurgery; Trigeminal neuralgia