Neurosurgery for Trigeminal Neuralgia

Abstract

As early as 1730, the first treatments for trigeminal neuralgia (TN) involved direct section of peripheral branches of the trigeminal nerve and later injection of caustic liquids. The main limitation of these simple peripheral destructive procedures was the short duration of pain relief [21]. Section of more central branches of the trigeminal nerve was first attempted by Victor Horsley in 1891, who, using a subtemporal intradural approach, cut the trigeminal root between the brainstem and the gasserian ganglia [11]. This approach was later popularized by Spiller and Frazier, who used a selective resection sparing the motor and first division fibers [7]. In 1925, Walter Dandy proposed a posterior fossa approach to partial sectioning of the sensory root at the pons and reported 500 cases in 1932 with excellent results [5]. Percutaneous approaches to the trigeminal ganglion commenced with direct injections of alcohol by Harris in 1912 [9]; however, although effective, alcohol leakage outside the cistern and production of other cranial neuropathies limited its applicability. In 1914, Hartel subsequently detailed a percutaneous technique for needle insertion outside the oral cavity using external landmarks which are still used today [10]. Percutaneous electrocoagulation of the ganglion was described by Kirschner in 1932 using a head frame and a diathermy apparatus [14]. In 1965, William Sweet introduced a less painful and safer technique which included intermittent sedation, physiological localization and controlled lesion production using radiofrequency [26].