Percutaneous Thermocoagulation of Trigeminal Ganglion

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Fifty-five patients with classical trigeminal neuralgia underwent percutaneous thermocoagulation of the trigeminal ganglion (PTTG). There were no failures attributable to anatomic abnormalities having prevented penetration of the foramen ovale. On the basis of immediate postoperative facial sensation, the patients were divided into three groups: anesthetic (n = 20), analgesic (n = 24), and hypesthetic (n = 11). All patients in the anesthetic group, 22 (92%) in the analgesic group, and eight (73%) in the hypesthetic group have remained pain-free postoperatively. The remaining patients' pain were reduced to a tolerable level. During follow-up, four patients in the analgesic group and three in the hypesthetic group experienced mild pain; only one required medical treatment for his pain. Three patients in the analgesic group and four in the hypesthetic group have had a full recurrence of pain, giving recurrence rates of 13% and 36%, respectively. Pain recurred at an average of 20 months postoperatively in the analgesic group and 7 months postoperatively in the hypesthetic group. We are following 45 patients required no surgical treatment after PTTG for 7 to 39 months. Masseter weakness was observed in nine (16%) of the 55 patients. Fourteen (25%) experienced unpleasant facial sensations, which were severe in two patients in the anesthetic group. Complete pain relief without recurrence was achieved in patients whose PTTG produced trigeminal anesthesia, and the degree of postoperative discomfort was directly related to the amount of sensory deficit produced. We concluded that accurate placement of the electrode in the trigeminal ganglion and a more precise lesioning with utilization of small graded increments of the temperature will be important to decrease the incidence of postsurgical complaints.
日本脳神経外科学会の論文
1987-01-15

Percutaneous Thermocoagulation of Trigeminal Ganglion

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