Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia

We analyzed 417 patients with trigeminal neuralgia who underwent microvascular decompression (MVD; n = 146) or percutaneous procedures, i.e. radiofrequency rhizotomy (RFR; n = 235) and glycerol rhizotomy (GR; n = 36) between March 1973 and December 1996. MVD and RFR showed the highest rates of initial pain relief (MVD 96.5%; RFR 92.3%; GR 82.8%). RFR and GR had 5.1 and 3.3% rates of facial dysesthesia, respectively, and MVD had the lowest rate (0.3%). Among 9 cases (8.6%) with recurrences after MVD, 8 cases underwent RFR and all of them obtained good long-term results (7.2 years on average). We concluded that MVD is the treatment of choice for tolerant younger patients and should be recommended for patients who desire no sensory deficit. We also determined that radiofrequency rhizotomy is the procedure of choice for patients in whom MVD failed.