Table 2.

Surgical interventions for TN

Procedure	Pain relief duration (Kaplan-Meier estimate)	Mortality	Morbidity	Comments
Peripheral i.e. cryotherapy, neurectomy, laser ablation, acupuncture, thermocoagulation, injections of alcohol / phenol	50% at 12 months	Nil	Localised sensory loss, haematoma formation, infection	Can be performed under local anaesthetic. Suitable for medically unfit for GA
(Evidence rating U - data inadequate / treatment unproven)
Gasserian ganglion i.e. radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression	50% at 5 years	Very low	Sensory loss >50% dysaesthesia <6% anaesthesia dolorosa 4% eye complications 4% meningitis 0.2%, up to 50% have masticatory deficit following balloon compression	Can be performed under heavy sedation or short GA. Often suitable alternative for patients unfit for MVD.
(Evidence rating C - Possibly effective / may be considered)				Glycerol rhizolysis provides shortest pain relief duration
Gamma knife	52% at 3 years	Nil	Problematic sensory loss 6–13% often six months later Anaesthesia dolorosa practically absent	The only non-invasive technique Pain relief can be delayed up to 6 months
(Evidence rating C - Possibly effective / may be considered)
Microvascular decompression	73% at 5 years	0.2 – 0.5%	Major post-operative morbidity 4% Ipsilateral hearing loss up to 10% Diplopia transiently Sensory loss 7%	Highest improvement in quality of life
(Evidence rating C - Possibly effective / may be considered)