The Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis using Percutaneous Radiofrequency Rhizotomy

2003 ◽  
Vol 30 (3) ◽  
pp. 220-223 ◽  
Author(s):  
Caglar Berk ◽  
Constantine Constantoyannis ◽  
Christopher R. Honey
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Pain Control ◽  
Bilateral Presentation ◽  
Facial Numbness ◽  
Poor Tolerance ◽  
Percutaneous Rhizotomy ◽  
Pain Distribution

ABSTRACT:Background:Trigeminal neuralgia (TN) has a higher incidence among patients with multiple sclerosis (MS) than in the general population. This cohort of MS patients with TN presents a series of management challenges including poor tolerance of antineuralgic medications and occasional bilateral presentation. We analyzed our surgical series of MS patients presenting with TN who were treated with percutaneous radiofrequency rhizotomy to estimate the success, failure and recurrence rate of this procedure for those patients.Methods:Surgical reports were retrospectively reviewed between the years 1996-2000. Patients with MS and TN who received a percutaneous rhizotomy during that time were included in the study and followed until the end of 2002. Data regarding age, sex, duration of MS and pain, response to medical treatment, pain distribution and surgical outcome were evaluated.Results:There were thirteen patients with MS and medically refractory TN treated with percutaneous radiofrequency rhizotomy. The average age at diagnosis for MS was 41 with TN beginning an average of eight years later. Following rhizotomy, complete pain relief without the need for any medication was achieved in 81% of the patients. The addition of medications resulted in pain control in the remaining patients. During a mean follow-up period of 52 months, there was a 50% recurrence rate. There were no complications related to the procedure and the associated facial numbness was well-tolerated.Conclusions:Percutaneous radiofrequency rhizotomy is a safe and effective method for the treatment of TN in patients with MS. The unique susceptibility of this cohort to the side effects of antineuralgic medications may require early consideration of rhizotomy.

scholarly journals Radiosurgery for multiple sclerosis–related trigeminal neuralgia: retrospective review of long-term outcomes

2019 ◽  
Vol 131 (5) ◽  
pp. 1583-1590 ◽  
Author(s):  
Colin J. Przybylowski ◽  
Tyler S. Cole ◽  
Jacob F. Baranoski ◽  
Andrew S. Little ◽  
Kris A. Smith ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Retrospective Review ◽  
Pain Control ◽  
Facial Pain ◽  
Salvage Treatment ◽  
Long Term Outcomes ◽  
Facial Numbness

OBJECTIVEThe objective of this study was to assess long-term outcomes of facial pain and numbness after radiosurgery for multiple sclerosis (MS)–related trigeminal neuralgia (MS-TN).METHODSThe authors conducted a retrospective review of their Gamma Knife radiosurgeries (GKRSs) to identify all patients treated for MS-TN (1998–2014) with at least 3 years of follow-up. Treatment and clinical data were obtained via chart review and mailed or telephone surveys. Pain control was defined as a facial pain score of I–IIIb on the Barrow Neurological Institute (BNI) Facial Pain Intensity Scale. Kaplan-Meier analysis was performed to determine the rates of pain control after index and first salvage GKRS procedures. Patients could have had more than 1 salvage procedure. Pain control rates were based on the number of patients at risk during follow-up.RESULTSOf the 50 living patients who underwent GKRS, 42 responded to surveys (31 women [74%], median age 59 years, range 32–76 years). During the initial GKRS, the trigeminal nerve root entry zone was targeted with a single isocenter, using a 4-mm collimator with the 90% isodose line completely covering the trigeminal nerve and the 50% isodose line abutting the surface of the brainstem. The median maximum radiation dose was 85 Gy (range 50–85 Gy). The median follow-up period was 78 months (range 36–226 months). The rate of pain control after the index GKRS (n = 42) was 62%, 29%, 22%, and 13% at 1, 3, 5, and 7 years, respectively. Twenty-eight patients (67%) underwent salvage treatment, including 25 (60%) whose first salvage treatment was GKRS. The rate of pain control after the first salvage GKRS (n = 25) was 84%, 50%, 44%, and 17% at 1, 3, 5, and 7 years, respectively. The rate of pain control after the index GKRS with or without 1 salvage GKRS (n = 33) was 92%, 72%, 52%, 46%, and 17% at 1, 3, 5, 7, and 10 years, respectively. At last follow-up, 9 (21%) of the 42 patients had BNI grade I facial pain, 35 (83%) had achieved pain control, and 4 (10%) had BNI grade IV facial numbness (very bothersome in daily life).CONCLUSIONSIndex GKRS offers good short-term pain control for MS-TN, but long-term pain control is uncommon. If the index GKRS fails, salvage GKRS appears to offer beneficial pain control with low rates of bothersome facial numbness.

CYBERKNIFE RADIOSURGERY AS A FIRST TREATMENT FOR IDIOPATHIC TRIGEMINAL NEURALGIA

Neurosurgery ◽  
2009 ◽  
Vol 64 (suppl_2) ◽  
pp. A96-A101 ◽  
Author(s):  
Laura Fariselli ◽  
Carlo Marras ◽  
Michela De Santis ◽  
Marcello Marchetti ◽  
Ida Milanesi ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Pain Control ◽  
Root Entry Zone ◽  
Successful Treatment Outcome ◽  
Robotic Radiosurgery ◽  
Idiopathic Trigeminal Neuralgia ◽  
Facial Numbness ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE To report the level of effectiveness and safety, in our experience, of CyberKnife (Accuray, Inc., Sunnyvale, CA) robotic radiosurgery as a first-line treatment against pharmacologically refractory trigeminal neuralgia. METHODS We treated 33 patients with the frameless CyberKnife system as a monotherapy. The retrogasserian portion of the trigeminal nerve (a length of 4 mm, 2–3 mm anterior to the root entry zone) was targeted. Doses of 55 to 75 Gy were prescribed to the 100% isodose line, according to a dose escalation protocol. The patients were evaluated for the level of pain control, time to pain relief, hypesthesia, and time to pain recurrence. RESULTS The median age was 74 years. All but 2 patients (94%) achieved a successful treatment outcome. The follow-up period was 9 to 37 months (mean, 23 months). The Barrow Neurological Institute Pain Intensity Scale (BPS) score before radiosurgery was III in 2 patients (6%), IV in 8 patients (24%), and V in 23 patients (70%). The time to pain relief was 1 to 180 days (median, 30 days). No facial numbness was observed. Only 1 patient developed a transitory dysesthesia of the tongue. After treatment, the BPS score was I, II, or III in 31 patients (97%). Pain recurred in 33% (11 patients) at a mean of 9 months (range, 1–43 months). Three patients with recurrences had low pain control by medication (BPS score, IV), and 1 patient (BPS score, V) needed a radiofrequency lesioning (BPS score, I at 12 months). CONCLUSION CyberKnife radiosurgery for trigeminal neuralgia allows pain relief at safe doses and is suggested for pharmacologically refractory trigeminal neuralgia. Higher prescribed doses were not associated with improvement in pain relief or recurrence rate.

scholarly journals Internal Neurolysis for the Treatment of Trigeminal Neuralgia: Systematic Review

2021 ◽  
Author(s):  
Victor Sabourin ◽  
Pascal Lavergne ◽  
Jacob Mazza ◽  
Fadi Al-Saiegh ◽  
Jeffrey Head ◽  
...  
Keyword(s):  
Systematic Review ◽  
Trigeminal Neuralgia ◽  
Treatment Options ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Pain Outcomes ◽  
Facial Numbness ◽  
Percutaneous Rhizotomy ◽  
The Impact

Introduction Trigeminal neuralgia remains a challenging disease with significant debilitating symptoms and variable efficacy in terms of treatment options, namely microvascular decompression (MVD), stereotactic radiosurgery (SRS), and percutaneous rhizotomy. Internal neurolysis (IN) is an alternative treatment that may be provide patient benefit but has limited understanding. We performed a systematic review of IN treatment of trigeminal neuralgia. Methods Studies from 2000 to 2021 that assessed IN in trigeminal neuralgia were aggregated and independently reviewed. Weighted averages for demographics, outcomes and complications were generated. Results A total of 520 patients in 12 studies were identified with 384 who underwent IN (mean age 53.8 years, range 46-61.4 years). A mean follow-up time of 36.5 months (range 12-90 months) was seen. Preoperative symptoms were present for about 55.0 months before treatment and pain was predominantly in V2/3 (26.8%) followed by other distributions. An excellent to good outcome (Barrow Neurological Institute Pain Score [BNI-PS] I-III) was seen in 83.7% of patients (range 72-93.8%). Pain outcomes at 1 year were excellent in 58-78.4%, good or better in 77-93.75% and fair or better in 80-93.75% of patients. On average facial numbness following IN was seen in 96% of patients however at follow-up remained in only 1.75-10%. The vast majority of remaining numbness was not significantly distressing to patients. Subgroup comparisons of IN vs. recurrent MVD, IN vs. radiofrequency ablation, the impact of IN during the absence of vascular compression as well as IN with and without MVD were also evaluated. Conclusions IN represents a promising approach for surgical treatment of trigeminal neuralgia in the absence of vascular compression or in potential cases of recurrence. Complications were limited in general. Further study is required to evaluate the impact of IN via higher quality prospective studies.

Linear accelerator–based radiosurgery for trigeminal neuralgia: comparative outcomes of frame-based and mask-based techniques

2021 ◽  
pp. 1-10
Author(s):  
Jenny C. Kienzler ◽  
Stephen Tenn ◽  
Srinivas Chivukula ◽  
Fang-I Chu ◽  
Hiro D. Sparks ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Pain Control ◽  
Linear Accelerator ◽  
Initial Response ◽  
Time To Recurrence ◽  
Facial Numbness ◽  
The Mean

OBJECTIVE Precise and accurate targeting is critical to optimize outcomes after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). The aim of this study was to compare the outcomes after SRS for TN in which two different techniques were used: mask-based 4-mm cone versus frame-based 5-mm cone. METHODS The authors performed a retrospective review of patients who underwent SRS for TN at their institution between 1996 and 2019. The Barrow Neurological Institute (BNI) pain score and facial hypesthesia scale were used to evaluate pain relief and facial numbness. RESULTS A total of 234 patients were included in this study; the mean age was 67 years. In 97 patients (41.5%) radiation was collimated by a mask-based 4-mm cone, whereas a frame-based 5-mm cone was used in the remaining 137 patients (58.5%). The initial adequate pain control rate (BNI I–III) was 93.4% in the frame-based 5-mm group, compared to 87.6% in the mask-based 4-mm group. This difference between groups lasted, with an adequate pain control rate at ≥ 24 months of 89.9% and 77.8%, respectively. Pain relief was significantly different between groups from initial response until the last follow-up (≥ 24 months, p = 0.02). A new, permanent facial hypesthesia occurred in 30.3% of patients (33.6% in the frame-based 5-mm group vs 25.8% in the mask-based 4-mm group). However, no significant association between the BNI facial hypesthesia score and groups was found. Pain recurrence occurred earlier (median time to recurrence 12 months vs 29 months, p = 0.016) and more frequently (38.1% vs 20.4%, p = 0.003) in the mask-based 4-mm than in the frame-based 5-mm group. CONCLUSIONS Frame-based 5-mm collimator SRS for TN resulted in a better long-term pain relief with similar toxicity profiles to that seen with mask-based 4-mm collimator SRS.

Gamma Knife surgery for recurrent or residual trigeminal neuralgia after a failed initial procedure

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 172-177 ◽  
Author(s):  
Chuan-Fu Huang ◽  
Shyh-Ying Chiou ◽  
Ming-Fang Wu ◽  
Hsien-Tang Tu ◽  
Wen-Shan Liu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Initial Treatment ◽  
Gamma Knife Surgery ◽  
Significant Difference ◽  
Facial Numbness ◽  
Initial Procedure

Object The purpose of this study was to assess outcomes of Gamma Knife surgery (GKS) as a second treatment for recurrent or residual trigeminal neuralgia (TN) after failure of 3 initial procedures: microvascular decompression (MVD), GKS, and percutaneous radiofrequency rhizotomy (PRR). Methods Between 1999 and 2008, 65 patients (31 men [48%] and 34 women [52%]) with recurrent TN were treated with GKS. All 65 patients had undergone previous medical procedures that failed to achieve sufficient pain relief: 27 patients (42%) had undergone MVD, 8 (12%) had undergone PRR, and 30 (46%) had undergone GKS as the initial treatment. The entry zone of the trigeminal nerve was targeted using a 4-mm collimator and treated with 35–90 Gy. The isocenter was positioned so that the brainstem surface was usually irradiated at an isodose no greater than 20% (59 patients) to 30% (6 patients). The median duration of TN symptoms in these patients was 39 months (range 1–192 months). Results At the clinical evaluation, 42 patients (65%) with idiopathic TN reported successful pain control at a median follow-up point of 64 months (range 18–132 months). Of these patients, 33 (51%) were no longer using medication. At the 1-, 2-, and 3-year follow-up examinations, 74%, 71%, and 66% of patients experienced successful pain control, respectively. There was no significant difference in pain relief in the initial MVD group compared with the initial GKS and initial PRR groups (74% vs 59% and 50%, respectively; p = 0.342). Recurrence of pain was noted in 23 patients. Twelve of these 23 patients underwent another GKS, resulting in pain control in 8 patients (67%); 8 other patients underwent MVD, resulting in pain relief in 7 patients (87.5%). The median time from GKS to pain recurrence was 7 months (range 3–48 months). There was no significant difference in new facial numbness among the 3 groups (p = 0.24); however, in the initial GKS group, facial numbness was significantly associated with freedom from pain (p = 0.0012). There was a significant correlation between the total radiation dose and facial numbness. The cutoff value for facial numbness ranged from 115 to 120 Gy (p = 0.037). Conclusions Gamma Knife surgery as a second treatment achieved acceptable levels of pain control in 65% of patients with residual or recurrent TN after long-term follow-up. Initial treatment was not a factor that affected pain control, but salvage surgery may be considered separately for each group.

scholarly journals Long-Term Results after Glycerol Rhizotomy for Multiple Sclerosis-Related Trigeminal Neuralgia

1994 ◽  
Vol 21 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
David J. Bissonette
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Surgical Procedures ◽  
Pain Control ◽  
Long Term Results ◽  
Sensory Loss ◽  
Single Patient

Abstract:Percutaneous retrogasserian glycerol rhizotomy (PRGR) was used during an 11-year interval in 53 patients with typical trigeminal neuralgia associated with multiple sclerosis. All patients had failed extensive medical trials prior to PRGR. Long-term (median follow-up, 36 months) complete pain relief (no further medication) was achieved in 29 (59%) of 49 evaluable patients. Eight patients (16%) had satisfactory pain control but required occasional medication. Twelve patients (25%) had initial unsatisfactory results with inadequate pain relief; nine underwent alternative surgical procedures. Sixteen patients (30%) subsequently required repeat glycerol rhizotomies to reachieve pain control. Twenty-seven patients (60% of 45 patients evaluated for this finding) retained normal trigeminal sensation after injection. Major trigeminal sensory loss developed in a single patient who had four glycerol rhizotomies over a 25-month interval. No patient developed deafferentation pain. We believe that PRGR is a low-morbidity, effective, and repeatable surgical procedure for the management of trigeminal neuralgia in the setting of multiple sclerosis.

scholarly journals Comparative study of Gamma Knife surgery and percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 175-180 ◽  
Author(s):  
David Mathieu ◽  
Khaled Effendi ◽  
Jocelyn Blanchard ◽  
Mario Séguin
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Pain Control ◽  
Pain Scale ◽  
Gamma Knife Surgery ◽  
Sensory Loss ◽  
Morbidity Rate

Object Among patients with multiple sclerosis (MS) there is a high incidence of trigeminal neuralgia (TN), and outcomes after treatment seem inferior to those in patients suffering from idiopathic TN. The goal of this study was to evaluate clinical outcomes in patients with MS-related TN after Gamma Knife surgery (GKS) and compare them with those obtained using percutaneous retrogasserian glycerol rhizotomy (PRGR). Methods The authors retrospectively reviewed the charts of 45 patients with MS-related TN. The first procedure undertaken was GKS in 27 patients and PRGR in 18 patients. Pain had been present for a median of 60 months (range 12–276 months) in patients who underwent GKS and 48 months (range 12–240 months) in patients who underwent PRGR. The following outcome measures were assessed in both groups of patients: pain relief (using the Barrow Neurological Institute [BNI] Pain Scale), procedure-related morbidity, time to pain relief and recurrence, and subsequent procedures that were performed. Results The median duration of follow-up was 39 months (range 13–69 months) in the GKS group and 38 months (range 2–75 months) in the PRGR group. Reasonable pain control (BNI Pain Scale Scores I–IIIb) was noted in 22 patients (81.5%) who underwent GKS and in 18 patients (100%) who underwent PRGR. For patients who underwent GKS, the median time to pain relief was 6 months; for those who underwent PRGR, pain relief was immediate. In the GKS group12 patients required subsequent procedures (3 patients for absence of response and 9 patients for pain recurrence), whereas in the PRGR group 6 patients required subsequent procedures (all for pain recurrence). As of the last follow-up, complete or reasonable pain control was finally achieved in 23 patients (85.2%) in the GKS group and in 16 patients (88.9%) in the PRGR group. The morbidity rate was 22.2% in the GKS group (all due to sensory loss and paresthesia) and 66.7% in the PRGR group (mostly hypalgesia, with 2 patients having corneal reflex loss and 1 patient suffering from meningitis). Conclusions Both GKS and PRGR are satisfactory strategies for treating MS-related TN. Gamma Knife surgery has a lower rate of sensory and overall morbidity than PRGR, but requires a delay before pain relief occurs. The authors propose that patients with extreme pain in need of fast relief should undergo PRGR. For other patients, both management strategies can lead to satisfactory pain relief, and the choice should be made based on patient preference and expectations.

Trigeminal nerve dysfunction after Gamma Knife surgery for trigeminal neuralgia: a detailed analysis

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 184-190 ◽  
Author(s):  
Shinji Matsuda ◽  
Osamu Nagano ◽  
Toru Serizawa ◽  
Yoshinori Higuchi ◽  
Junichi Ono
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Trigeminal Nerve ◽  
Pain Control ◽  
Gamma Knife Surgery ◽  
Clinical Visit ◽  
Facial Numbness ◽  
Nerve Dysfunction ◽  
Free Status

Object Gamma Knife surgery (GKS) is an effective treatment option for intractable trigeminal neuralgia (TN). The incidence of trigeminal nerve dysfunction, such as facial numbness or dysesthesia, has been reported to be higher than previously published, and the degree and prognosis of trigeminal nerve dysfunction has not been well evaluated. The authors evaluated the incidence, timing, degree, and outcome of trigeminal nerve dysfunction after GKS for TN. Methods One hundred four patients with medically refractory TN were treated by GKS. Thirty-nine patients were men and 65 were women; their median age at GKS was 74 years. Using a single isocenter and a 4-mm collimator, 80 or 90 Gy was directed to the trigeminal nerve root. Follow-up data were obtained at clinical examinations every 3–6 months after GKS. Each patient's pain-control status and degree of trigeminal nerve dysfunction were recorded. The incidence, timing, and degree of dysfunction (assessed using the Barrow Neurological Institute facial numbness scale [BNI-N]) and the prognosis and factors related to trigeminal nerve dysfunction were analyzed. Results The median duration of follow-up in these patients was 37 months (range 6–121 months). At the final clinical visit, a pain-free status was still observed in 71 patients (68.3%). In 51 patients (49.0%), new or increased trigeminal nerve dysfunction developed at a median of 10.5 months (range 4–68 months) after GKS. In 24 patients (23.1%), this dysfunction was categorized as BNI-N Score II, in 20 patients (19.2%) as BNI-N Score III, and in 7 patients (6.7%) as BNI-N Score IV. Among those patients, 18 patients, including 3 patients with BNI-N Score IV, experienced improvement in nerve dysfunction between 24 and 108 months after GKS (median 52.5 months). At the final clinical visit, 43 patients (41.3%) reported having some trigeminal nerve dysfunction: in 26 patients (25.0%) this was categorized as BNI-N Score II, in 13 patients (12.5%) as BNI-N Score III, and in 4 patients (3.8%) as BNI-N Score IV. The only independent factor that was correlated to all trigeminal nerve dysfunction and also specifically to bothersome trigeminal nerve dysfunction was pain-free status at the final clinic visit. Conclusions The incidence of trigeminal nerve dysfunction after GKS for TN was 49%. The severity of the dysfunction improved in one-third of the afflicted patients, even in those with severe dysesthesia at long-term follow-up. A strong relationship between TN and good pain control was identified.

Microvascular Transposition Without Teflon: A Single Institution's 17-Year Experience Treating Trigeminal Neuralgia

2021 ◽  
Vol 20 (4) ◽  
pp. 397-405
Author(s):  
Andrew R Pines ◽  
Richard J Butterfield ◽  
Evelyn L Turcotte ◽  
Jose O Garcia ◽  
Noel De Lucia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Postoperative Pain ◽  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Microvascular Decompression ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Trigeminal Nerve Root

Abstract BACKGROUND Trigeminal neuralgia (TN) refractory to medical management is often treated with microvascular decompression (MVD) involving the intracranial placement of Teflon. The placement of Teflon is an effective treatment, but does apply distributed pressure to the nerve and has been associated with pain recurrence. OBJECTIVE To report the rate of postoperative pain recurrence in TN patients who underwent MVD surgery using a transposition technique with fibrin glue without Teflon. METHODS Patients were eligible for our study if they were diagnosed with TN, did not have multiple sclerosis, and had an offending vessel that was identified and transposed with fibrin glue at our institution. All eligible patients were given a follow-up survey. We used a Kaplan-Meier (KM) model to estimate overall pain recurrence. RESULTS A total of 102 patients met inclusion criteria, of which 85 (83%) responded to our survey. Overall, 76 (89.4%) participants responded as having no pain recurrence. Approximately 1-yr pain-free KM estimates were 94.1% (n = 83), 5-yr pain-free KM estimates were 94.1% (n = 53), and 10-yr pain-free KM estimates were 83.0% (n = 23). CONCLUSION Treatment for TN with an MVD transposition technique using fibrin glue may avoid some cases of pain recurrence. The percentage of patients in our cohort who remained pain free at a maximum of 17 yr follow-up is on the high end of pain-free rates reported by MVD studies using Teflon. These results indicate that a transposition technique that emphasizes removing any compression near the trigeminal nerve root provides long-term pain-free rates for patients with TN.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

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