A new Mayo Clinic study found that posterior fossa exploration surgery provided significantly better pain relief than stereotactic radiosurgery for patients with trigeminal neuralgia. This study was presented at the American Association of Neurological Surgeons Annual Meeting in San Diego on May 5, 2009.
Trigeminal neuralgia is characterized by episodes of intense, stabbing, electric-shocklike pain in areas of the face which have branches of the trigeminal nerve (lips, eyes, nose, scalp, forehead, upper jaw and lower jaw). The trigeminal nerve carries sensation from the face to the brain. In trigeminal neuralgia, the nerve function is disrupted. Approximately 15,000 patients are diagnosed with trigeminal neuralgia each year in the U.S.
“Medical therapy eliminates or significantly reduces the pain for 75 percent of patients with trigeminal neuralgia, but the effectiveness generally decreases over time and surgery becomes necessary for patients to maintain their quality of life,” says Bruce Pollock, M.D., a neurosurgeon at Mayo Clinic and the lead author of this study. “In posterior fossa exploration surgery, the hope is to find a blood vessel pushing onto the trigeminal nerve that can be moved or displaced. We consider this to be the gold standard of trigeminal neuralgia surgeries. Stereotactic radiosurgery, on the other hand, directs radiation onto the nerve with the hope of creating a mild degree of damage to relieve patients of facial pain.”
Dr. Pollock and his team reviewed the records of 149 patients who had posterior fossa exploration surgery or stereotactic radiosurgery for trigeminal neuralgia between June 2001 and September 2007. Prior to surgery, patients were informed that posterior fossa exploration surgery was most likely to relieve facial pain without causing numbness. Sixty-one percent of patients chose to undergo posterior fossa exploration, while 39 percent opted for stereotactic radiosurgery.
The researchers found that patients who had posterior fossa exploration were more than two times more likely to achieve and maintain pain relief without the need for medications. Additionally, posterior fossa exploration surgery was found to be safe, and the incidence of facial numbness was much lower after posterior fossa exploration surgery than after stereotactic radiosurgery.
Below is a link to an edited youtube video with Dr. Pollock .