ما هو العلاج الجراحي لألم العصب ثلاثي التوائم عند عدم كفاية العلاج الدوائي؟

References

• Microvascular decompression (MVD) should be considered in those patients with neurovascular compression on imaging, and who are fit to undergo a general anaesthetic.
• Some neurosurgeons will carry out internal neurolysis ('nerve combing') if no vascular compression is found at the time of the surgery.
• Percutaneous neuroablative procedures at the Gasserian ganglion level — includes radiofrequency thermocoagulation, balloon compression and glycerol rhizolysis.
• Neuroablative treatments should be the preferred surgical intervention if MR imaging does not demonstrate any neurovascular compression and medical management is insufficient.
• Stereotactic Radiosurgery (SRS) — radiosurgery for TN unlike other surgical interventions is minimally invasive, does not require sedation or general anaesthesia and is typically performed as a day case procedure.
• SRS is considered a primary alternative to the invasive surgical techniques and has been found to be safe according to national guidelines.
• Peripheral procedures — these procedures involve treating the terminal branches of the trigeminal nerve, and hence depend on accurate assessment of which nerve branch is acting as the trigger area.
• The relevant nerve branch can then either be injected with alcohol, or surgically exposed and treated with cryotherapy or neurectomy.