Mayo Clinic Finds Posterior Fossa Exploration Surgery Provides Best Pain Relief for Trigeminal Neuralgia

Monday, May 04, 2009

ROCHESTER, Minn. — A new Mayo Clinic study found that posterior fossa exploration surgery provided significantly better pain relief than stereotactic radiosurgery for patients with trigeminal neuralgia. This study will be presented at the American Association of Neurological Surgeons Annual Meeting in San Diego on May 5, 2009.

Video Alert: Additional audio and video resources, including excerpts from an interview with Dr. Pollock describing the research, are available on the Mayo Clinic News Blog These materials are also subject to embargo, but may be accessed in advance by journalist for incorporation into stories. The password for this post is AANS54.

Trigeminal neuralgia is characterized by episodes of intense, stabbing, electric-shock-like pain in areas of the face which have branches of the trigeminal nerve (lips, eyes, nose, scalp, forehead, upper jaw and lower jaw). The trigeminal nerve carries sensation from the face to the brain. In trigeminal neuralgia, the nerve function is disrupted. Approximately 15,000 new patients are diagnosed with trigeminal neuralgia each year in the U.S.

"Medical therapy eliminates or significantly reduces the pain for 75 percent of patients with trigeminal neuralgia, but the effectiveness generally decreases over time and surgery becomes necessary for patients to maintain their quality of life," says Bruce Pollock, M.D., a neurosurgeon at Mayo Clinic and the lead author of this study. "In posterior fossa exploration surgery, the hope is to find a blood vessel pushing onto the trigeminal nerve that can be moved or displaced. We consider this to be the gold standard of trigeminal neuralgia surgeries. Stereotactic radiosurgery, on the other hand, directs radiation onto the nerve with the hope of creating a mild degree of damage to relieve patients of facial pain."

Dr. Pollock and his team reviewed the records of 149 patients who had posterior fossa exploration surgery or stereotactic radiosurgery for trigeminal neuralgia between June 2001 and September 2007. Prior to surgery, patients were informed that posterior fossa exploration surgery was most likely to relieve facial pain without causing numbness. Sixty-one percent of patients chose to undergo posterior fossa exploration, while 39 percent opted for stereotactic radiosurgery. The researchers found that patients who had posterior fossa exploration were more than two times more likely to achieve and maintain pain relief without the need for medications. Additionally, posterior fossa exploration surgery was found to be safe, and the incidence of facial numbness was much lower after posterior fossa exploration surgery than after stereotactic radiosurgery.

"Over the past 10 years, patient preference has emerged as an important deciding factor for surgical intervention, and a large number of patients choose stereotactic radiosurgery since it is less invasive," says Dr. Pollock. "However, this study shows that the results with posterior fossa exploration surgery are far better. Therefore, we typically recommend posterior fossa exploration as the first line of management for patients requiring surgical treatment for trigeminal neuralgia."

Also on the Mayo Clinic research team was Kimberly Schoeberl, R.N.

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