Abstract
BACKGROUND: Partial sensory rhizotomy (PSR) is an "ultima ratio" procedure for patients with therapy-refractory trigeminal neuralgia (TN). The treatment can be offered to patients without a neurovascular conflict or to patients who did not benefit either from previous microvascular decompression (MVD) or from other interventional procedures. This study presents our experience with PSR. METHODS: Our prospectively maintained database was searched for patients who underwent PSR. We conducted a retrospective analysis of all patients with PSR. Clinical data, MR imaging, surgical videos, and OR notes were evaluated and a telephone interview for the last follow-up was done. RESULTS: Our search revealed 48 patients treated with PSR between 2004 and 2023. The average age was 59.4 years. Mean history of symptoms was 7.81 years (1-30 years). All types of previous treatments were included. Fifteen patients suffered from multiple sclerosis. A total pain relief was observed in 42 patients immediately after PSR, two patients had a partial pain improvement, and four patients observed no difference. An expected, variable hypesthesia occurred in 37 patients. The most common procedure was a PSR of the lower third. The mean follow-up was 38 months (3-183 months), five patients were lost to follow-up. 28 patients still had complete, 13 partial pain relief. Ten patients still needed medications but were satisfied with a lower dose and generally improved or were even pain-free. Thirteen patients who had benefited from the PSR initially, reported recurrent TN. Five of them received a second PSR after 5-55 months with complete pain relief. CONCLUSION: Early after surgery patient satisfaction regarding pain relief/improvement was 92.7% (44 of 48 patients). During follow-up we observed complete or partial pain relief in 31 of 43 patients (72.1%) without pain medication, another 23.3% were satisfied with on-going medication. However, the degree of sensitive deficits is not predictable. Because of our convincing results, patients should be informed about PSR as a therapeutic option for therapy-refractory or recurrent TN. It may be considered either instead of, or as an alternative to, percutaneous procedures or radiosurgery.