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>
Hello,
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
pressure.
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
