Table 2.
Summary of Transcutaneous, Percutaneous, Radiotherapy, and Open Surgical Treatment Options for Patients with Trigeminal Neuralgia
| Patient Selection Criteria | Initial Pain Relief Rates | Pain Recurrence | References | |
|---|---|---|---|---|
| Transcutaneous | ||||
| TENS | Retractable disease without pain relief after medication | 80–90% within 3 weeks | 85% Reduction in pain after 3 months, but long term outcomes are not well studied | [34,52,160,209] |
| Focused ultrasound | Failed standard therapies, but further study is needed | Further study is needed | Further study is needed | [217,218] |
| Transcranial MR cortical stimulation | May be used as assessment method for cortical stimulation | 50–60% | Long-term studies are lacking | [221,222] |
| Percutaneous | ||||
| Chemodenervation | ||||
| Glycerol | Failed medical management | 70–90+% | 20–40% Have pain relief | [126,128,130,131,136–138,143,144,149,152–154,156–165,181,282] |
| Alcohol | Failed medical management | 80–90% success rate | >50% Require retreatment | [6,37,95,142,145–147,151] |
| Phenol | Failed medical management; end-stage cancer patients | 80–90% | ~40% Recurrence 1–2 years after procedure | [123,148–155] |
| Radiofrequency ablation | Failed medical management | 75–95+% | 25–50% Recurrence | [4,130,143,168,174–176,181] |
| Nerve blocks | Failed medical management | 30–40% | Pain relief may last longer than expected based on local anesthetic’s duration of action, 50–60% have sustained pain relief | [7,34,116,117,122,145–147,149,151,176,191–193,277] |
| Balloon compression | Failed medical management | 80–90+% | 15–50% | [46,124–141,143,230] |
| Cryoablation | Failed standard therapy | 90+% | 30–40% | [184,186,188] |
| Botox injection | Failed standard therapies | 50–60% | 50–60% Require second dose at 2 months, long term outcomes need further study | [63,80,83,194–205,246] |
| Nerve stimulation | Most commonly treating Type 2 TN in literature | 40–50% but sample size is limited | Long-term outcomes need further study | [211–213] |
| Radiotherapy | ||||
| Radiosurgery | Patients who cannot tolerate general anesthesia or invasive procedures | Pain relief is not immediate; maximum time to pain relief is around 180 days after treatment | 20–30% | [4,7,10,38,41,54,64,71,80,120,130,135,143,175,177,223–246,274] |
| Open surgery | ||||
| Microvascular decompression | Ability to tolerate general anesthesia and suboccipital craniectomy | >90% | ~10% Underwent second operations; most recurrences within 2 years of surgery | [4,7,10,24,54,58,61–63,65,66,71,78,80,130,131,134–136,143,163,169,171,174,175,177,184,226,230,240,245,246,252–265,267–272,274,275] |
| Partial sensory rhizotomy | Absence of neurovascular contact on MRI | 80–90%; Similar to slightly worse than MVD patients | Worse than MVD, 47% pain free at 5 years | [171,177,263,269–274] |
| Peripheral neurectomy | Failed medical therapy or severe medical comorbidities and unable to tolerate MVD suboccipital craniectomy | 70–90+% | Up to 20%, Recurrence thought to be secondary to peripheral nerve regeneration | [276–281,283] |
| Deep brain stimulation | Refractory TN, excluding patients with psychogenic or factitious pain disorders, cognitive impairment, and psychiatric disease | >90%, but sample size is small | 60% Require medication on follow-up, but long term outcomes are not well studied | [34,214,215,246] |
| Motor cortex stimulation | rTMS may be used as an initial assessment for cortical stimulation | 60–80+%, but further studies are needed | >50%, but long-term outcomes are poorly studied | [219–222] |