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Vol. 35. Issue 5.
Pages 247-252 (September - October 2024)
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Vol. 35. Issue 5.
Pages 247-252 (September - October 2024)
Clinical Research
Partial sensory rhizotomy in recurrent trigeminal neuralgia. Our experience and literature review
La rizotomia parcial sensitiva en la neuralgia del trigémino recurrente. Nuestra experiencia y revisión de la literatura
Jorge Díaz-Molinaa,
Corresponding author
jdiazmolina1@gmail.com

Corresponding author.
, Javier Ordunab, David Riveroa, Paula Alcázara, Luis Manuel Gonzáleza
a Hospital Universitario Miguel Servet, Zaragoza, Spain
b Hospital MAZ, Zaragoza, Spain
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Figures (1)
Tables (3)
Table 1. Barrow Neurological Institute (BNI) pain intensity score.
Table 2. Descriptive table of patients.
Table 3. Summary of PSTR in the literature.
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Additional material (1)
Abstract
Background and objective

Trigeminal Neuralgia (NT) is a common pathology in Neurosurgery. It can be classified as idiopathic or secondary to other pathologies, such as Multiple Sclerosis (MS). Several surgical treatments have been described, some of them being replaced by more modern techniques. Partial sensory rhizotomy (PSR), described by Dandy is a technique replaced by other techniques due to its permanent side effects. We present our experience with this technique in patients with recurrent NT.

Methods and materials

A retrospective review is carried out on five patients who underwent surgery at our center from 2018 to 2023 using the PSR technique.

Results

All the patients intervened showed significant clinical improvement, except one patient who required reintervention due to uncontrolled pain. According to the Barrow Neurological Institute (BNI) scale, 80% (4/5) of patients showed improvement from grade V to grades I/II except for one of them. This patient suffered from MS. Additionally, one patient presented a corneal ulcer after surgery due to impairment of the corneal reflex.

Conclusion

In our experience, PSR is a valid treatment option in selected patients with recurrent TN. It has a low incidence of complications with an adequate surgical technique and anatomical knowledge of the region. To the best of our knowledge, we are one of the few centers in Spain to publish our results with PSR in the last ten years. We report good results in pain control withdrawing medication in 80% (4/5) of the operated patients.

Keywords:
Trigeminal neuralgia
Multiple sclerosis
Partial sensory rhizotomy
Resumen
Antecedentes y objetivo

La Neuralgia del Trigémino (NT) es una patología común para los neurocirujanos, pudiendo clasificarse en idiopática o secundaria a otras patologías como la esclerosis múltiple (EM). Se han descrito múltiples tratamientos quirúrgicos que han ido evolucionando a lo largo del tiempo. Los efectos secundarios permanentes de la rizotomía parcial sensitiva (RPS) descrita por Dandy, hicieron que esta técnica fuera sustituida por otras menos agresivas. Exponemos nuestra experiencia con esta técnica en pacientes con NT recurrente.

Material y métodos

Se realiza una revisión retrospectiva de cinco pacientes intervenidos en nuestro centro desde el año 2018 hasta el 2023 mediante la técnica de la RPS del trigémino.

Resultados

Todos los pacientes operados presentaron mejoría clínica significativa, siendo necesario reintervenir a uno de ellos por persistencia del dolor. Según la escala del Barrow Neurological Institute (BNI), un 80% de los pacientes (4/5) mejoraron de un grado V a un grado I/II. El restante presentaba EM. Como complicación inesperada, un paciente presentó una úlcera corneal tras la cirugía por afectación del reflejo corneal.

Conclusión

En nuestra experiencia, la RPS es una opción válida de tratamiento en pacientes seleccionados. Presenta baja incidencia de complicaciones con una adecuada técnica quirúrgica y conocimiento anatómico de la zona. Según la literatura disponible, somos uno de los pocos centros en España que publica sus resultados con la RPS en la última década. En nuestra serie observamos buenos resultados en el control del dolor, pudiendo retirar la medicación en el 80% (4/5) de los casos.

Palabras clave:
Neuralgia trigeminal
Esclerosis múltiple
Rizotomía parcial sensitiva

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