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Toronto Notes 2019 Surgical Management for Trigeminal Neuralgia Neurosurgery NS41 Surgical Management for Trigeminal Neuralgia
• reservedforcasesrefractorytomedicalmanagement;seeNeurology,N42formedicalmanagement
Surgical Options
• trigeminalnervebranchprocedures
■ local blocks (phenol, alcohol)
■ neurectomy of the trigeminal branch
■ nerve branches
■ V1 block at the supraorbital, supratrochlear nerves
■ V2 block at the foramen rotundum or infraorbital nerves ■ V3 block at the foramen ovale
• percutaneoustrigeminalrhizotomy
■ glycerol injection
■ mechanotrauma via catheter balloon
• radiofrequencythermocoagulation • GammaKnife®radiosurgery
• microvasculardecompression
■ posterior fossa craniotomy with microsurgical exploration of the root entry zone, displacement of the vessel impinging on the nerve with placement of non-absorbable Teflon® felt
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