Névralgie du trijumeau et neurochirurgie

Control of primary trigeminal neuralgias, when becoming pharmaco-resistant, is almost always possible by modern neurosurgery. Two types of methods are available: 1°) percutaneous techniques interrupting the pain pathways, such as the retrogasserian thermorhizotomy at the triangular plexus, the balloon compression of the gasserian ganglion in Meckel's cave, the glycerol injection within the trigeminal cistern, and the stereotactic radiosurgery of the trigeminus using the Gamma-Knife which may be an alternative of those; 2°) the microvascular decompression of the trigeminal root at the cerebello-pontine angle. This technique consists of dissecting free the root from the cross-compressing offending vessel(s) and needs a direct approach and general anaesthesia; it must be reserved to patients under 70-75 years of age, with good general conditions. For elderly patients and/or patients with precarious general conditions, a percutaneous technique or radiosurgery is preferable, which duration of efficacy is proportional to degree of post-operative residual hypoesthesia.