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    Treatment of trigeminal neuralgia with glycerol injection at the gasserian ganglion
    (Masson Editeur, 2009) Sindou, M.; Tatli, M.
    Gasserian ganglion neurolysis with glycerol injected percutaneously through the foramen ovale continues to be widely used. Its long-term efficacy on pain is proportional to the degree of postoperative hypoesthesia. The advantage is low cost. The disadvantage is essentially the difficulty in controlling diffusion outside the Meckel cavity. Subsequently its effects are somewhat random and potential complications are difficult to prevent reliably. (C) 2009 Elsevier Masson SAS. All rights reserved.
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    Treatment of trigeminal neuralgia with thermorhizotomy
    (Masson Editeur, 2009) Sindou, M.; Tatli, M.
    Percutaneous radiofrequency (RF) thermorhizotomy of the trigeminal nerve is an effective treatment for trigeminal neuralgia. Long-term efficacy is proportional to the degree of postoperative hypoesthesia. The advantage is the topographic selectivity of the thermolesion, provided the electrode tip is placed accurately. This requires precise x-ray guidance and neurophysiological testing. In addition to the indication in idiopathic trigeminal neuralgia. especially for elderly patients with precarious conditions. thermorhizotomy is particularly useful for treating patients with trigeminal neuralgia due to multiple sclerosis. It can also be applied to symptomatic neuralgias. but only when the main components are of the paroxysmal and/or the allodynic types: the thermorhizotomy method could aggravate permanent components. especially when burning pain predominates it could also increase preexisting trophic disturbances. particularly keratitis. (C) 2009 Elsevier Masson SAS. All rights reserved.
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    Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes
    (Springer Wien, 2008) Tatli, M.; Satici, O.; Kanpolat, Y.; Sindou, M.
    Background. The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. Method. All studies that had a minimum 5 years or more (>= 5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student's t-test, Chi-square followed by Pearson's risk analysis tests were used. Kaplan-Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. Findings. Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. Conclusions. The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.