role of peripheral neurectomies in the treatment of trigeminal neuralgia in modern practice

ABSTRACT

50 patients were analyzed for indications, advantages and complications of peripheral neurectomies from June 2003 to September 2008 reported to the Department of Dentistry and Maxillofacial Surgery, Lady Reading Hospital, Peshawar. We selected only those patients who were above 40 years. After neurectomies, 35 [70% of patients had excellent pain relie lasting 2-5 years without any medication; 4 [8%] patients experienced occasional pain but no medication required; in 5 [10%] patients pain controlled with medication where as in 6[12%] patients, recurrence of pain appeared in 0-2 years which could not be controlled with medication. These patients were referred to neurosurgeon for MVD [Microvascular Decompression]. Both surgical and medical therapies are effective for trigeminal neuralgia. However, factors such as pain relief, recurrence mates and morbidity and mortality rates should be taken into account when considering which technique to use. It seems proper to start a patient suffering from trigeminal neuralgia with medical therapy but proceed early with surgical treatment if pain control is poor or side effects of medication are intolerable. The loss of sensation along the branch of the trigeminal nerve and recurrence rate are associated with peripheral neurectomy. But it is an effective and safe procedure for elderly patients; particularly those who have short life span. And in centers where facilities are not available for major neurosurgical procedures or patient is not fit for such procedures, neurectomy is-the best choice. It is possible even under local anesthesia