There are two versions of Trigeminal Neuralgia – one version that just has episodic sharp pains, and another that has that and also a continuous pain component. Those with a continuous component do poorly.
Acta Neurochir (Wien). 2010 Oct 16. [Epub ahead of print]
Surgical treatment of trigeminal neuralgia. Results from the use of glycerol
injection, microvascular decompression, and rhizotomia.
Degn J, Brennum J. abstract here
- Classified TN into:
- Type 1 – sharp lancinating episodic pain – 69%
- Type 2 – above plus a constant burning, dull background pain – 31%
- IN 1/5 of cases epilepsy drugs do not work and other procedures need to be considered. These include Trigeminal glycerin injection, Microvascular decompression, and Trigeminal thermocoagulation.
- In Trigeminal Glycerin injection, type did not make a difference – but whether or not paresthesias – numb funny feeling(Hypo group) occurred subsequently:
Either way, long term results don’t look that great.
For radiofrequency denaturation and microvascular decompresssion, TN type was significant:
For type 2 TN, both procedures faired poorly in long term – certainly the radiofrequency would not be even worth considering for type 2 TN. Type 1s do well with either radiofrequency or microvascular decompression.
Comment – this suggests the pathological basis of type 2 TN might be distinct – this needs work. For type 2, it looks like one could start with trigeminal glycerin injection and pray for numb paresthesias…