Tratamiento neuroquirúrgico mínimamente invasivo de la neuralgia del trigémino: Rizotomia percutánea con balón

Pablo Hernández; Humberto Prinzo; Aurana Erman; Fernando Martínez

Authors

Pablo Hernández ASSE, Hospital Regional de Tacuarembó, Unidad de Neurocirugía Funcional y Estereotaxia, Coordinador. Hospital Maciel, Unidad Académica Asociada - Servicio de Neurocirugía, Departamento de Neurocirugía Funcional y Estereotaxia, Jefe
Humberto Prinzo Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Neurocirugía, Equipo de Neurocirugía Funcional y Estereotaxia, Jefe
Aurana Erman Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Neurocirugía, Equipo de Neurocirugía Funcional y Estereotaxia
Fernando Martínez Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Neurocirugía, Equipo de Neurocirugía Funcional y Estereotaxia, Asistente

Keywords:

TRIGEMINAL NEURALGIA, RHIZOTOMY

Abstract

Introduction: essential trigeminal neuralgia is an extremely incapacitating disease, and, in spite of pharmacological treatment being effective in the first stages, a certain percentage of patients become refractory. In these cases, neurosurgical treatment is considered as a valid option.
Method: a restrospective analysis of the casuistics was conducted for patients who were treated with percutaneous trigeminal rhizotomy in Tacuarembó's Regional Hospital, in Hospital Maciel, in the University Hospital and in several private healthcare institutions in Montevideo, the capital city, and in the rest of the country. A total of 95 patients were operated from December 2004 through September 2010; 29 patients were operated under neuroleptic analgesia and 66 under general anesthesia. Technique-specific trocar needles and Fogarty(r) Nº 4 catheters were used. In all cases, image intensifiers were used for the localization of the oval whole. Average hospital stay was 48 hours for non-complicated cases.
Results: 100% of patients were completely relieved from pain in the immediate post-operative period. Follow-up ranged from two months to five years. In all cases, medication was suspended within three to four months after surgery. Out of the patients operated between 2004 and 2008, which correspond to the sub-group of patients whose follow-up lasted at least two years, pain recidivated in 16% of cases. One patient (1%) evidenced complications. There was no mortality in this group.
Conclusions: percutaneous baloon rhizotomy is a very safe technique, and it is very effective to relieve pain, enabling the suspension of pharmacological treatment, which in many cases results in severe side effects, and it is also possible to be repeated in the event of recidivism, achieving very good results.

References

(1) Seijo F. Neuralgia del trigémino. Rev Soc Esp Dolor 1998; 5(1): 70-8.
(2) Beaver DL. Electron microscopy of the gasserian ganglion in trigeminal neuralgia. J Neurosurg 1967; 26(1 Suppl):138-50.
(3) Kerr FW. Correlated light and electron microscopic observations on the normal trigeminal ganglion and sensory root in man. J Neurosurg 1967; 26(1 Suppl): 32-7.
(4) Kerr FW. Pathology of trigeminal neuralgia: light and electron microscopic observations. J Neurosurg 1967; 26(1 Suppl): 151-6.
(5) Sweet W. The pathophysiology of trigeminal neuralgia. In: Gildenberg P, Tasker R, eds. Textbook of stereotactic and functional neurosurgery. New York: McGraw-Hill 1998: 1667-82.
(6) Haines SJ, Jannetta PJ, Zorub DS. Microvascular relations of the trigeminal nerve: an anatomical study with clinical correlation. J Neurosurg 1980; 52(3): 381-6.
(7) Martuza RL, Ojemann RG, Shillito J Jr, Wepsic JG. Facial pain associated with a middle fossa arachnoid cyst. Neurosurgery 1981; 8(6): 712-6.
(8) Cheng JS, Sánchez-Mejía RO, Limbo M, Ward MN, Barbaro NM. Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis. Neurosurg Focus 2005; 18(5): e13.
(9) Abarca-Olivas J, Sempere AP, Cortés-Vela JJ, Baño-Ruiz E, Nieto-Navarro J, Botella Asunción C. Influencia de la platibasia en la neuralgia del trigémino. Rev Neurol 2009; 49(12): 630-2.
(10) Neira F, Ortega JL. La neuralgia postherpética: ¿un problema sin resolver? Rev Soc Esp Dolor 1998; 5(2): 128-43.
(11) Robaina F. Neuralgia del trigémino: revisión del tratamiento médico y quirúrgico. Rev Soc Esp Dolor 2008; 15(4): 248-56.
(12) Moore K, Burchiel K. Surgical management of trigeminal neuralgia. In: Tindall G, Cooper P, Barrow D, eds. The Practice of Neurosurgery. Baltimore: Williams & Wilkins, 1996: 3043-64.
(13) Piatt JH Jr, Wilkins RH.Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 1984; 4(4): 462-71.
(14) Bederson JB, Wilson CB. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 1989; 71(3): 359-67.
(15) Burchiel KJ, Clarke H, Haglund M, Loeser JD. Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 1988; 69(1): 35-8.
(16) Molina-Foncea A, García-Navarrete E, Calvo JC, Sola RG. La descompresión microvascular en el tratamiento de la neuralgia esencial del trigémino. Rev Neurol 1998; 27 (155): 65-70.
(17) Szapiro J, Sindou M, Szapiro J. Prognoctic factors in microvascular decompression for trigeminal neuralgia. Neurosurgery 1985; 17(6): 920-9.
(18) Pollack IF, Jannetta PJ, Bissonette DJ. Bilateral trigeminal neuralgia: a 14 years experience with microvascular decompression. J Neurosurg 1988; 68(4): 559-65.
(19) Sluijter ME. Radiofrequency: thoracic and cervical region, headache and facial pain. Meggen (LU): Flivo Press, 2001: 85-97.
(20) Taha JM, Tew JM. Radiofrequency rhizotomy for trigeminal and other cranial neuralgias. In: Gildenberg P, Tasker R, eds. Textbook of stereotactic and functional neurosurgery. New York: McGraw-Hill, 1998: 1687-96.
(21) Gerber A, Mullan S. Trigeminal nerve compression for neuralgia. In: Gildenberg P, Tasker R, eds. Textbook of stereotactic and functional neurosurgery. New York: McGraw-Hill, 1998: 1707-13.
(22) Brown JA, Mullan JF. Percutaneous trigeminal nerve compression. In: Schmidek HH ed. Operative neurosurgical techniques: indications, methods and results. Philadelphia: W.B. Saunders, 2000: 1552-9.
(23) Martínez Suárez JE, Salva S, de Jongh WA. Estudio comparativo entre termocoagulación retrograsseriana y la microcompresión con balón catéter en la neuralgia trigeminal. Rev Soc Esp Dolor 2005; 12(1): 3-7.
(24) Brown JA, Pilitsis JG. Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring. Neurosurg Focus 2005; 18(5): e10.
(25) Brown JA, Hoeflinger B, Long PB, Gunning WT, Rhoades R, Bennett-Clarke CA, et al. Axon and ganglion cell injury in rabbits after percutaneous trigeminal balloon compression. Neurosurgery 1996; 38(5): 993-1003.
(26) López BC, Hamlyn PJ, Zakrzewska JM. Stereotactic radiosurgery for primary trigeminal neuralgia: state of the evidence and recommendations for futures reports. J Neurol Neurosurg Psychiatry 2004; 75(7): 1019-24.
(27) Martínez-Moreno NE, Martínez-Álvarez R, Rey-Portolés G, Gutiérrez-Sárraga J, Burzaco-Santurtún J, Bravo G. Tratamiento mediante radiocirugía con Gamma Knife (r) de la neuralgia del trigémino y del dolor facial atípico. Rev Neurol 2006; 42(4): 195-201.
(28) Sweet WH, Poletti CHE. Complications of percutaneous rhizotomy and microvascular decompression operations for facial pain. In: Schmidek HH, Sweet HW, eds. Operative neurosurgical techniques: indications, methods and results. Philadelphia: W.B. Saunders, 2000: 1595-8.
(29) Arrese I, Lobato RD, Alen JF, Lagares A, Miranda P. Acute subdural and intratemporal hematoma as a complication of percutaneuos compression of the gasserian ganglion for trigeminal neuralgia. Neurocirugía 2005; 16(2): 177-82.
(30) Langford P, Holt ME, Danks RA. Cavernous sinus fistula following percutaneous ballon compression of the trigemnial ganglion. J Neurosurg 2005; 103(1): 176-8.