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Madhusudan Natarajan m-natarajan at nwu.edu
Tue Oct 21 11:32:56 EST 1997

In article <62ht46$2sg$1 at columbine.singnet.com.sg>, "Mohan Tiru" 
<mohant at mbox2.singnet.com.sg> wrote:
>Other than Antidepressants and Anticonvulsants, are there any other
>treatment modalities for trigeminal neuralgia, including surgical options.
>Plse email mohant at mbox3.singnet.com.sg


        Im not in the clinical side of neuroscience, and I cannot advice on 
what the current most common method of treatment. I thought I would however 
write you on different procedures that can potentially be adopted. Standard 
Disclaimer : You are advised to consult a neurologist/neurosurgeon about this. 
I am just helping to provide some background information.

  Also : [ I started writing this out earlier but my mailer crashed. If you 
receive another verison of the same mail in a garbled fashion, please ignore 
it. ]

Generally, invasive treatment is not recommended. Drug therapy is usually the 
first line of treatment, but in cases where the condition is refractive to 
pharmaceutical therapy, the following surgical procedures can be adopted.

Microvascular decompression was a common method of treatment a few years ago 
(maybe even now?). Basically, implants (padding material - usually teflon) are 
transposed between the impinging blood vessel and the nerve to relieve the 

Some lesser invasive percutaneous techniques like Glycerol blocks (injection 
to say gasserian ganglion) are also followed. I think percutaneous balloon 
compression to "injure" myelinated fibers of the nerve was also proposed. I 
dont know how effective that one is/was but I seem to remember recurrence 
rates of as high as 25%.

Radiofrequency thermocoagulation was also followed some time back, but there 
were fewer followers of that technique on account of the fact that there is 
accompanying sensory loss.

Theres a couple of groups (I think U Pitt and Seattle) that were actively 
pushing forward the Gamma Knife Radiosurgery neurectomy as an alternative that 
was supposedly even better than microvascular decompression. Im a little hazy 
on this but I think I read a little about this technique in BMJ a while ago.

Data seems to vary on what was/is the most advantageous method to be adopted. 
There are several tradeoffs. I think MVD was among the leading contenders for 
being the most effective technique However, it IS an invasive process, and all 
the cons of invasive processes like mortality (however low) and morbidity go 
with it. There are added factors like the age of the patient, and lesser 
invasive procedures are often followed in patients greater than 50 years of 
age, when say dealing with the posterior fossa.. or generally an craniotomy.
A lot of decisions on the exact procedure adopted depend on how refratory the 
TN is to drug therapy, condition of patient etc.

I hope this helps.

Madhusudan Natarajan

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