Facial pain, a comparison of treatments Open print version

Overview

Several disorders that cause facial pain can be successfully treated by neurosurgical procedures. It is important to accurately diagnose the disorder and identify the best treatment for each disorder. In the absence of randomized prospective studies, standardized methods of reporting, and standardized outcome criteria, it is difficult to compare the results of various surgical procedures and the different reported series of the same surgical procedure. Nevertheless, several important observations emerge from reviews of the literature and personal experience.

General Observations on Facial Pain

  • Accurate diagnosis is required.
  • The diagnosis of typical Trigeminal Neuralgia (TGN) is seldom difficult.
  • In general, the length of the list of the patients symptoms is directly proportional to the likelihood of treatment failure.
  • Medical treatment should be explored before surgery is contemplated.
  • There is no successful surgical procedure for treatment of atypical facial pain.
  • It is more difficult to treat neuropathic than neuralgic pain.
  • Patients with dysesthetic pain seldom respond to ablative surgery.
  • There is no single superior treatment for facial pain. The treatment should be individualized. Patients should have access to a broad spectrum of treatment options.
  • The results of surgical treatment diminish as facial pain becomes more chronic.

Bibliography

  1. Taha JM, Tew JM Jr. Comparison of surgical treatments for trigeminal neuralgia: Reevaluation of radiofrequency rhizotomy. Neurosurgery 1996;38:865-871.
  2. Tew JM Jr, Taha JM. Percutaneous rhizotomy in the treatment of intractable facial pain (trigeminal, glossopharyngeal, and vagal nerves). In: Schmidek HH, Sweet WH, eds. Operative neurosurgical techniques. 3rd ed.  Philadelphia: W.B. Saunders, 1995:1469-1484.
  3. Sindou M, Amrani F, Mertens P. Microsurgical vascular decompression in trigeminal neuralgia. Comparison of 2 technical modalities and physiopathologic deductions. A study of 120 cases. Neurochirugie 1990;36:16-25.
  4. Cutbush K, Atkinson R. Treatment of trigeminal neuralgia by posterior fossa microvascular decompression. Aust N Z J Surg 1994;64:173-176.
  5. Mendoza N, Illingworth R. Trigeminal neuralgia treated by microvascular decompresssion: A long-term follow-up study. Br J Neurosurg 1995;9:13-19.
  6. Barker F, Jannetta P, Bissonette D, Larkins M, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996;334(17):1077-1083.
  7. Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery 1997;40:46-51.
  8. Lee KH, Chang JW, Park YG, et al. Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia. Stereotact Funct Neurosurg 1997;68:196-199.
  9. Pagura J, Rabello J, De Lima W. Microvascular decompression for trigeminal neuralgia. In: Gildenberg P, Tasker R, eds. Textbook of stereotactic and functional neurosurgery. New York: McGraw-Hill, 1996:1715-1721.
  10. Miserocchi M, Cabrini G, Motti E, et al. Percutaneous selective thermorhizotomy in the treatment of essential trigeminal neuralgia. J Neurosurg Sci 1989;33:179-183.
  11. Ischia S, Luzzani A, Polati E, et al. Percutaneous controlled thermocoagulation in the treatment of trigeminal neuralgia. Clin J Pain 1990;6:96-104.
  12. Zakrzewska J, Thomas D. Patientís assessment of outcome after three surgical procedures in the management of trigeminal neuralgia. Acta Neurochir (Wien) 1993;122:225-230.
  13. Taha JM, Tew JM Jr. A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 1995;83:989-993.
  14. Waltz T, Dalessio D, Copeland B, et al. Percutaneous injection of glycerol for the treatment of trigeminal neuralgia. Clin J Pain 1989;5:195-198.
  15. Ischia S, Luzzani A, Polati E. Retrogasserian glycerol injection: A retrospective study of 112 patients. Clin J Pain 1990;6:291-296.
  16. De La Porte C, Verlooy J, Veeck G, et al. Consequences and complications of glycerol injection in the cavum of Meckel: A series of 120 consecutive injections. Stereotact Funct Neurosurg 1990;54-55:73-75.
  17. Steiger H. Prognostic factors in the treatment of trigeminal neuralgia. Analysis of a differential therapeutic approach. Acta Neurochir (Wien) 1991;113:11-17.
  18. Cappabianca P, Spaziante R, Graziussi G, et al. Percutaneous retrogasserian glycerol rhizolysis for treatment of trigeminal neuralgia. Technique and results in 191 patients. J Neurosurg Sci 1995;39:37-45.
  19. Bergenheim A, Hariz M, Laitinen L, Olivecrona M, Rabow L. Relation between sensory disturbance and outcome after retrogasserian glycerol rhizotomy. Acta Neurochir (Wien) 1991;111:114-118.
  20. Jho HD, Lunsford D: Percutaneous retrogasserian glycerol rhizotomy. Neurosurg Clin North Am 1997;8(1):63-74.
  21. Hakanson S, Linderoth B. Injection of glycerol into the gasserian cistern for treatment of trigeminal neuralgia. In: Gildenberg P, Tasker R, eds. Textbook of stereotactic and functional neurosurgery. New York: McGraw-Hill, 1998:1697-1706.
  22. Kondziolka D, Lunsford D, Habeck M, Flickinger J. Gamma knife radiosurgery for trigeminal neuralgia. Neurosurg Clin North Am 1997;8(1):79-85.
  23. Young R, Vermeulen S, Grimm P, Blasko J, Posewitz A. Gamma knife radiosurgery for treatment of trigeminal neuralgia: Idiopathic and tumor related. Neurology 1997;48:608-614.
  24. Rand R. Leksell gamma knife treatment of tic douloureux. Neurosurg Clin North Am 1997;8(1):75-78.
  25. Addennebi B, Mahfouf L, Nedjahi T. Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia. Stereotact Funct Neurosurg 1997;68:190-195.
  26. Brown J, Gouda J. Percutaneous balloon compression of the trigeminal nerve. Neurosurg Clin North Am 1997;8(1):53-62.
  27. Linskey M, Jho HD, Jannetta P. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression. J Neurosurg 1994;81:1-9.
  28. Cho DY, Chang C, Wang YC, et al. Repeat operations in failed microvascular decompression for trigeminal neuralgia. Neurosurgery 1994;35:665-670.
  29. Yamaki T, Hashi K, Niwa J, et al. Results of reoperation for failed microvascular decompression. Acta Neurochir (Wien) 1992;115(1-2):1-7.
  30. Rath S, Klein H, Richter H. Findings and long-term results of subsequent operations after failed microvascular decompression for trigeminal neuralgia. Neurosurgery 1996;39:933-938.
  31. Rappaport Z, Gomori J: Recurrent trigeminal cistern glycerol injections for tic douloureux. Acta Neurochir (Wien) 1988;90(1-2):31-34.
  32. Resnick D, Jannetta P, Lunsford D, et al. Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis. Surg Neurol 1996;46:358-361.
  33. Kondziolka D, Lunsford L, Bissonette D. Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia. Can J Neurol Sci 1994;21:137-140.
  34. Puca A, Meglio M. Typical trigeminal neuralgia associated with posterior cranial fossa tumors. Ital J Neurol Sci 1993;14:549-552.
  35. Jamjoom A, Jamjoom Z, Al-Fehaily M, et al. Trigeminal neuralgia related to cerebellopontine angle tumors. Neurosurg Rev 1996;19:237-241.
  36. Barker I, Peter J, Babu R, et al. Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 1996;84:818-825.
  37. Cheng T, Cascino T, Onofrio B. Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 1993;43:2298-2302.
  38. Taha JM, Tew JM Jr. Surgical management of glossopharyngeal and other uncommon facial neuralgias. In: Tindall G, Cooper P, Barrow D, eds. The practice of neurosurgery. Baltimore: Williams & Wilkins, 1996:3065-3080.
  39. Taha JM, Tew JM Jr. Long-term results of surgical treatment of idiopathic neuralgias of the glossopharyngeal and vagal nerves. Neurosurgery 1995;36(5):926-931.
  40. Sindou M, Henry J, Blanchard P. Idiopathic neuralgia of the glossopharyngeal nerve. Study of a series of 14 cases and review of the literature. Neurochirurgie 1991;37:18-25.
  41. Wakiya K, Fukushima T, Miyazaki S. Results of microvascular decompression in 16 cases of glossopharyngeal neuralgia. Neurol Med Chir (Tokyo) 1989;29(12):1113-1118.
  42. Resnick D, Jannetta P, Bissonnette D, et al. Microvascular decompression for glossopharyngeal neuralgia. Neurosurgery 1995;36:64-69.
  43. Taha JM, Tew JM Jr, Keith R, et al. Intraoperative monitoring of the vagus nerve during intracranial glossopharyngeal and upper vagal rhizotomy. Technical note. Neurosurgery 1994;35:775-777.
  44. Kanpolat Y, Savas A, Batay F, Sinav A. Computed tomography-guided trigeminal tractotomy-nucleotomy in the management of vagoglossopharyngeal and geniculate neuralgias. Neurosurgery 1998;43:484-490.
  45. Kirkpatrick P, OíBrien M, MacCabe J. Trigeminal nerve section for chronic migrainous neuralgia. Br J Neurosurg 1993;7:483-490.
  46. Grigorian IUA, Ogleznev KIA, Roshchina NA. Surgical treatment of migrainous neuralgia. Zh Vopr Neirokhir im N N Burdenko 1995;4:16-19.
  47. Taha JM, Tew JM Jr. Long-term results of radiofrequency rhizotomy in the treatment of cluster headache. Headache 1995;35:193-196.
  48. Sanders M, Zuurmond W. Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: A 12- to 70-month follow-up evaluation. J Neurosurg 1997;87:876-880.
  49. Ford R, Ford K, Swaid S, Jennelle R. Gamma knife treatment of refractory cluster headache. Headache 1998;38:3-9.

Sources

Through the Trigeminal Neuralgia Association (TNA), local support groups are available. The support group provides an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments, pain control, and medications. Additional information is available on the web at www.tna-support.org or facial-neuralgia.org

If you would like information about the Greater Cincinnati Trigeminal Neuralgia Support Group, please call the Mayfield Clinic at (513)569-5290. For support outside Greater Cincinnati, please contact the Trigeminal Neuralgia Association at 800-923-3608.

The following journal articles and books formed the basis of our observations along with our own personal experience. Bibliography listing.


updated: 6.2004
originally published > Tew JM, Taha JM: Therapeutic Decisions in Facial Pain. Clinical Neurosurgery 46:410-431, 2000