Document Type : Original Article
Authors
1 Neurosurgery Department, College of Medicine, University of Sulaimanil, Sulaimani, Iraq.
2 General medicine and surgery Department, College of Medicine, University of Sulaimanil, Sulaimani, Iraq.
Abstract
Background: Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder affecting the trigeminal nerve, often resulting in debilitating, paroxysmal facial pain. While pharmacologic therapies are first-line treatments, many patients eventually require surgical intervention due to poor response or medication intolerance. Percutaneous gasserian rhizotomy (PGR) is a minimally invasive neurosurgical procedure that targets the Gasserian ganglion to provide long-term pain relief.
Aim: To evaluate the long-term outcomes of PGR in patients with TN in terms of pain relief, sensory complications, recurrence, and patient satisfaction over a follow-up period extending up to 10 years.
Methods: We conducted a retrospective cohort study involving 55 patients who underwent Percutaneous gasserian rhizotomy (PGR) for trigmeinal neuralgia (TN). Variables such as age, gender, affected trigeminal branch, Visual Analogue Scale (VAS) pain scores pre- and post-treatment, number of previous PGRs, sensory loss, and long-term outcomes (up to 10 years in some patients) were analyzed.
Results: Preoperatively, 90.9% of patients reported severe pain (VAS ≥9). Post-PGR, a significant reduction in pain was observed, with the mean VAS decreasing from 9.45 (SD = 0.83) to 0.98 (SD = 2.12) at 1 week (p-value < 0.001). Long-term follow-up revealed sustained pain relief, with VAS scores of 1.47 at 1 year, 2.22 at 2 years, and 3.03 at 5 years. Complete sensory loss was observed in only 2 patients and partial sensory loss in 20 patients postoperatively, neither was significantly associated with pain outcomes (p-value = 0.147). At the final assessment, 72.7% of patients had favorable outcomes (no or mild pain).
Conclusion: PGR is a safe and effective long-term treatment for TN, offering substantial and sustained pain relief with a low risk of serious complications. It is particularly valuable in resource-limited settings or for patients unsuitable for more invasive options like microvascular decompression.
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