Trigeminal Neuralgia: A Comparison of the Results of Percutaneous Rhizotomy and Microvascular Decompression

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Abstract
Patients (75) were treated for classical idiopathic tic douloureux; 55 patients underwent percutaneous trigeminal rhizotomy (PTR) and 24 had posterior fossa microvascular decompression (MVD) of the trigeminal nerve. Four patients had both procedures. In the PTR group, 4% were immediate failures, 42% had a delayed recurrence of pain, while 54% remained totally pain-free with an average follow-up of 30 mo. In the MVD group, 12% were immediate failures, 17% had a delayed recurrence of pain and 71% have remained free of pain with an average follow-up of 28 mo. Neither procedure can be regarded as ideal surgical treatment for patients with pain refractory to medical treatment. Percutaneous rhizotomy has an established place because of its safety, particularly in elderly patients. A high rate of recurrent pain is to be expected. Microvascular decompression is preferable in younger patients because of its nondestructive nature, but the long-term efficacy of the procedure is not known.