Minimally invasive neurosurgical treatment of trigeminal neuralgia
Percutaneous balloon Rhizotomy
Abstract
Introduction: essential trigeminal neuralgia is an extremely incapacitating disease, and, in spite of pharmacological treatment being effective in the first stages, a certain percentage of patients become refractory. In these cases, neurosurgical treatment is considered as a valid option.
Method: a restrospective analysis of the casuistics was conducted for patients who were treated with percutaneous trigeminal rhizotomy in Tacuarembó's Regional Hospital, in Hospital Maciel, in the University Hospital and in several private healthcare institutions in Montevideo, the capital city, and in the rest of the country. A total of 95 patients were operated from December 2004 through September 2010; 29 patients were operated under neuroleptic analgesia and 66 under general anesthesia. Technique-specific trocar needles and Fogarty(r) Nº 4 catheters were used. In all cases, image intensifiers were used for the localization of the oval whole. Average hospital stay was 48 hours for non-complicated cases.
Results: 100% of patients were completely relieved from pain in the immediate post-operative period. Follow-up ranged from two months to five years. In all cases, medication was suspended within three to four months after surgery. Out of the patients operated between 2004 and 2008, which correspond to the sub-group of patients whose follow-up lasted at least two years, pain recidivated in 16% of cases. One patient (1%) evidenced complications. There was no mortality in this group.
Conclusions: percutaneous baloon rhizotomy is a very safe technique, and it is very effective to relieve pain, enabling the suspension of pharmacological treatment, which in many cases results in severe side effects, and it is also possible to be repeated in the event of recidivism, achieving very good results.
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