Therapiemöglichkeiten der trigeminusneuralgie - Chirurgische verfahren im fokus

Introduction: Classical trigeminal neuralgia is caused by vascular compression of the trigeminal nerve. Pain control can often be achieved by antiepileptic medication. Interventional procedures may be considered where symptom control is inadequate or side effects unacceptable. Methods: Selective literature review taking into account relevant guidelines. Results: Positive long term results following vascular decompression lend support to the rationale that vascular compression is etiological. Hence idiopathic trigeminal neuralgia has, in principle, become a curable condition. Patients unfit for surgery due to their age or medical condition may benefit from radiosurgery using the gamma knife. Percutaneous thermocoagulation and glycerol infiltration also have a place in these patients. Radiosurgery and percutaneous procedures share the disadvantage of sensory loss and a 50 % recurrence rate within 5 years. Discussion: Greater tailoring of the intervention to the individual patient is now possible, but minimally invasive procedures are associated with high rates of sensory deficit and recurrence.