Medically Refractory Trigeminal Neuralgia: A Comparative Study of Outcomes of Microvascular Decompression versus Gamma Knife Radiosurgery and Percutaneous Radiofrequency Ablation

Abstract

Objective

The surgical options for medically refractory trigeminal neuralgia (TN) are diverse, with limited comparative evidence. This study evaluates and compares pain-free period and time to recurrence for patients who underwent microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and radiofrequency ablation (RFA).

Methods

A retrospective review of patients with medically refractory TN over a 10-year period from 2009 to 2018 at a tertiary neurosurgical center was performed. Patients with at least 1 year of follow-up after the treatment procedure were included. Clinical details, radiological records, intraoperative findings, and treatment details of radiosurgery and ablative procedures were recorded.

Results

A total of 189 patients were included, the mean age being 52.54 (± 13.3) years, with a male:female ratio of 1.52:1. The mean duration of symptoms was 70.19 (± 57.6) months, with 86.3% of patients presenting with type 1 neuralgia. The median follow-up duration was 84, 100, and 67 months for MVD, GKRS, and RFA, respectively. The percentages of patients with favorable outcomes (Barrow Neurological Institute Pain Intensity Score [BNI I–IIIa]) were 87.8, 67.3, and 66.5%, respectively, for MVD, GKRS, and RFA. The median pain-free intervals were 65, 59, and 36 months, with recurrence rates of 24.2, 25, and 40.5% for MVD, GKRS, and RFA, respectively.

Conclusion

This study reaffirms MVD as the best first-line treatment for medically refractory TN, with GKRS being a useful alternative in patients who are surgically unfit or unwilling, and an optimum second-line treatment for those with recurrences. RFA is useful as an adjunct in patients unfit for surgery, with a high initial efficacy albeit with high recurrence rates.

Keywords

neurovascular conflict - neuralgia - microsurgery - percutaneous - radiosurgery - functional - stereotactic

Previous Presentation

Poster of Distinction presented at 34th Annual Meeting of the North American Skull Base Society (NASBS) and 9th World Congress of the World Federation of Skull Base Societies, New Orleans, Louisiana, United States, February 13 to 16, 2025.

Publication History

Received: 10 May 2025

Accepted: 17 June 2025

Accepted Manuscript online:
18 June 2025

Article published online:
27 June 2025

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