The trigeminal tract and nucleus procedures in treatment of atypical facial pain.

BACKGROUND

Atypical facial pain (AFP) is a throbbing pain situated deep in the eye and malar region, often radiating to the ear, neck, and shoulders. The pain generally is not within any dermatomal or anatomical boundaries. Atypical facial pain is distinct from trigeminal neuralgia and its variants. Therefore, the treatment of AFP should be specified. There is also no consensus in the treatment of AFP. Two different treatment procedures on the trigeminal tract and nucleus in a series of cases with AFP are presented.

METHODS

Between 1989 and 2005, 17 patients with AFP, in whom previous therapies had failed, underwent computed tomography (CT)-guided percutaneous trigeminal tractotomy-nucleotomy (TR-NC). One patient with unfavorable response to TR-NC underwent trigeminal dorsal root entry zone (DREZ) operation.

RESULTS

In the series with AFP, pain relief was achieved in all of the 17 cases. TR-NC provided maximum to inadequate degrees of pain relief in 16 of 17 patients. Dorsal root entry zone operation provided partial relief in 1 case. Neither mortality nor serious permanent complication was observed in the series.

CONCLUSION

Neurosurgical procedures such as TR-NC or trigeminal DREZ operation may be effective in the treatment of intractable AFP. The primary choice of operation should be TR-NC because this procedure is minimally invasive. Trigeminal DREZ operation, which affects a larger spread area, may follow if TR-NC fails. The indications and procedure of choice should be individually tailored, depending on the type of pain, underlying pathology, and experience of the surgeon.