Internal Neurolysis for the Treatment of Trigeminal Neuralgia: Systematic Review

Introduction: Trigeminal neuralgia (TN) is a pain syndrome commonly treated with microvascular decompression when an offending vessel is identified. However, internal neurolysis (IN) has become increasingly utilized as an adjunct or standalone therapy when no neurovascular compression (NVC) is identified, or as a salvage procedure for TN unresponsive to other treatment modalities.

Methods: A literature search was performed using the search terms: “Trigeminal Neuralgia, Neurolysis,” “Trigeminal Neuralgia, Internal Neurolysis,” and “Trigeminal Neuralgia, Microvascular Decompression, Neurolysis” resulting in 57 articles. After accounting for duplicates, eliminating non-English articles, and screening by title to remove alternative methods of treatment, a total of 17 articles remained. Articles without a case series or that did not differentiate the results of IN from other treatments were excluded. Nine articles were considered for final analysis in the systematic review (Table 1). PRISMA guidelines were followed for the systematic review ([Fig. 1]).

Results: A total of 459 patients were included in the 9 studies, 323 (70.4%) of whom underwent an IN. With a mean/median range of follow-up of 12 to 90 months, results for Barrow Neurological Institute—Pain Score (BNI-PS): I: immediate postoperative rates ranged: 85 to 94.6%, 1-year rates ranged: 58 to 78.4%, and overall rates ranged: 47 to 82.1%. Results for BNI-PS: I/II showed: immediate postoperative rates ranged: 96 to 100%, 1-year rates ranged: 77 to 93.75%, and overall rates ranged from: 62.5 to 87.1%. Results for BNI-PS: I-III showed: immediate postoperative rates ranged: 96 to 100%, 1-year rates ranged: 80 to 93.75%, and overall rates ranged from: 80 to 100% ([Fig. 2]). The recurrence of any pain at 1-year ranged from: 3.92 to 42%, and overall rates ranged from: 3.6 to 50%. When considering significant recurrence of pain as BNI-PS: I/II → III–V the 1-year recurrence rates ranged from: 3.92 to 17%, and overall recurrence rates ranged from: 3.6 to 25% ([Fig. 3]).

Conclusion: IN represents a reasonable primary or secondary treatment option for TN with low grade or no NVC. Pain control rates seem comparable to standard MVD, but more data on long-term outcomes are needed to assess the durability of the intervention.

 

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No conflict of interest has been declared by the author(s).