Effectiveness and safety of surgical treatment of classic and Idiopathic trigeminal neuralgia

Abstract text (incl. figure legends and references)
QUESTION Surgical treatment of trigeminal neuralgia (TN) is indicated in refractory cases. Different percutaneous and invasive techniques can be performed. This study aims to analyze the effectiveness and safety of these procedures. METHODS A retrospective observational single-center study of patients with classic or idiopathic refractory TN (failure to 3 different groups of drugs). Clinical, diagnostic-therapeutic, and clinical evolution data were collected. RESULTS We included 70 patients (60% female), with a median age at diagnosis of 56 [23-82], 48(69%) had classic TN. The mean number of previous drugs used was 4.24 (SD±2.25). 47 patients (67%) were treated with microvascular decompression (MVD), being effective in 87% (52% total, 35% partial) and achieving medication withdrawal in 15. 11 (23.4%) presented complications; major, yet reversible, in 3 cases. In 42 (60%) percutaneous techniques were used. 26 (37.1%) underwent radiofrequency thermocoagulation (1.77 times per patient on average) with a response rate of 60% (12% total, 48% partial), complications appeared in 7 (17.4%), 3 of which were major and persistent. 16 (34.8%) underwent balloon compression (1.25 times per patient) with 84% effectiveness (56% total, 25% partial), 4 (25%) minor complications were registered, 75% of which were persistent. In 17 patients (24%) both techniques were used (47% DCMV as the first option). 2 gangliolysis, 1 stereotactic radiosurgery, and 1 implantation of cortex stimulation device were performed, with no subsequent complications. CONCLUSIONS Surgical techniques are effective in patients with refractory TN, allowing to reduce medication use. The technique that offers the best results is MVD. Complications may appear in up to a quarter of patients, regardless of the technique used, being more frequent and persistent, contrary to expectations, in percutaneous procedures.