TRIGEMINAL NEURALGIA





INTRODUCTION



The first Description of a disease like trigeminal neuralgia we get from the writings of Ibn Sina (980-1073) in an arabic text. The first attempt to treat trigeminal neuralgia was done by John Locke in 1677, who applied sulphuric acid to the face to treat trigeminal neuralgia' Trigeminal neuralgia successfully treated for the first time by alcohol injection by Pitres in 1902. First RF lesioning for this ganglion was described by Sweet and Vepsic in 1965, First Retro-gasserian glycerol injection was done by Hakanson in 1981. Percutaneous balloon compression was performed by Mullan and Lichtor in 1978 for the first time.



Interventional treatment options of trigeminal neuralgia



Percutaneous Glycerol Rhizolysis



This is the simplest technique in which 50- 90 % glycerol in injected at trigeminal ganglion. The average duration of pain relief is 6 months to 1 year. The procedure can be repeated. Foraminal Fibrosis may occur by repeated injection.



Percutaneous Radiofrequency (RF) Rhizolysis



This is the treatment of choice for trigeminal neuralgia in aged and can also be done in young individual. The pain relief period is much longer compared to other techniques. This procedure may be done as day care procedure.



Percutaneous Balloon Micro-Compression



In this technique 4 Fr Fogarty catheter is inserted through 14G, 10 cm needle. The balloon is kept inflated there for 60 seconds to 120 seconds to selectively block a delta and c fibers. Pain relief period is 2- 74 months in different studies,



Stereotactic Radiation Therapy (Gamma knife)



Stereotactic Radiation Therapy is one of the non-invasive treatment for trigeminal neuralgia. Pain, Pain relief is not immediate, it takes around 3 months for onset. Only one third of patients gets complete pain relief. Number of studies is still limited regarding efficacy though the procedure is safe.



Trigeminal Ganglion Cryotherapy



A comparatively newer mode of neurolysis, Showing good results in trigeminal neuralgia.



Gassarian Ganglion Stimulation. (Experimental)



Trigeminal Ganglion Stimulation can be tried when other modalities are not effective.



Surgical Microvascular Decompression



Microvascular Decompression is a surgical technique in which the ganglion is separated from the aberrant vessel with sponge after doing craniotomy.