Ronald Tasker Award: retreatment of medically refractory trigeminal neuralgia.

INTRODUCTION Multiple modalities have been adapted to treat medically refractory trigeminal neuralgia (TN). Until recently, the preferred treatment modality was microvascular decompression (MVD),9 especially if a vessel was thought to be abutting the trigeminal nerve entry zone. Less-invasive techniques have since been developed. Percutaneous ablation is one technique that uses radiofrequency (RF), pressure, or chemolysis to provide instantaneous relief by lesioning the nerve. Even less invasive is radiosurgery (RS), which uses stereotaxy to lesion the nerve. The degree of invasiveness is important, as is the treatment efficacy. MVD was the first treatment to be rigorously tested. The results showed a significant reduction of pain in four of five patients.2,7 Conversely, 20 to 30% of patients have persistent TN pain and require retreatment.1,2,4 Recurrent symptoms typically surface after 1.9 years,2 thus, the length of follow-up in published studies is very important. Refractory or recurrent TN is also seen with other treatment modalities.3,6,11,13,14 At this time, there have been no prospective randomized controlled studies comparing the different treatment modalities for TN with respect to effectiveness. In this chapter, we evaluated patients with idiopathic TN who were prospectively entered into our University of California, San Francisco (UCSF) TN Database and required retreatment after MVD, RS, or RF. We compare the effectiveness of each treatment modality.