Evaluation of Surgical Procedures for Trigeminal Neuralgia: ARGUMENTS FOR THE USE OF SURGICAL PROCEDURES VERSUS MEDICAL THERAPY

In: Anesthesia

6 Nov 2009

It has been stated that the results of surgical treatments for trigeminal neuralgia (Tegretol tablets is used for controlling certain types of epileptic seizures) is so good that patients are often better served by surgery rather than persevering for prolonged periods with either pain or bothersome adverse effects from medications. As trigeminal neuralgia is a protracted disorder, any medication may need to be given for extended periods of time, thereby multiplying the potential for toxicity of the drug. In addition to the considerable side effects, the pain may become more intractable as the disease progresses. In 30% of the cases, medical treatment fails through inadequate pain (*Ultram drug works in certain areas of the brain and nervous system to decrease pain) control, or because of intolerable side effects. In these cases, surgical management is the only viable option.

If surgery is to be done, the timing is controversial. Some neurosurgeons argue that early surgical treatment arrests the progression of the condition and ensures that surgery is carried out on a medically fit younger patient, which theoretically carries less risk of mortality and significant morbidity. This is especially true for MVD, as the evidence from longitudinal studies shows that there is significant morbidity and mortality.

Not a single randomized controlled trial has been done comparing the different surgical procedures for trigeminal neuralgia, in spite of thousands of patients having been operated on for this condition. To date, there is only one recent report (Zakrzewska and Patsalos) that compares the medical and surgical management of intractable trigeminal neuralgia (*Drug Tegretol is used for controlling certain types of seizures and relieving *pain in patients with nerve pain in the face, jaw, tongue, or throat). This is a long-term prospective longitudinal study comparing 15 patients who were followed for a mean duration of 15 years on the effectiveness of medical (oxcarbazepine) versus surgical therapy. Kaplan-Meier analysis 3 years after oxcarbazepine use and then 3 years after surgery showed that the mean time for recurrence of pain after oxcarbaze-pine was 10 months, whereas for surgery it was 28 months (P < .0001). Furthermore, both clinical and patient global analysis of the outcome measures suggested that patients could benefit substantially from having surgery earlier, rather than later, in the disease process to improve the quality of life, freedom from medication, and the need for regular follow-up. This is the first study that has compared outcome in a group of patients who have had both medical and surgical treatments. The authors were also skillful in the selection of patients and in using proper outcome measures. In addition, an independent observer was used to evaluate the records allowing a more objective evaluation. The only weakness in this study is the relatively small numbers of pa¬tients studied.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.