Complications seen from percutaneous ablative therapy for trigeminal neuralgia have been extensively documented. The oral mucosa may be penetrated during the approach, resulting in bacterial meningitis or brain abscess. A carotid-cavernous fistula may result from injury to the internal carotid artery. There is a possibility of otalgia from eustacian tube dysfunction, or temporomandibular joint tenderness along with jaw weakness. Aseptic meningitis has been reported, as well as intracranial hemorrhage from acute hypertension. Other reported complications are bradycardia with subsequent hypotension, neurokeratitis, temporary diplopia, optic nerve injury, subdural hematoma, postoperative herpes simplex activation, bothersome facial sensory loss and dysesthesias, and anesthesia dolorosa [18,19]. These potential morbidities need to be discussed with patients as part of the preoperative meeting even though the risk of their occurrence is 2% or less.
As long as the surgical endpoint selected is mild to moderate hypes-thesia, there will be a recurrence rate of 20% to 25%, depending on the time elapsed after surgery, with recurrence rates being twice as high for trigeminal neuralgia associated with multiple sclerosis. Recurrent pain occurs either because of regeneration of injured myelin or from progression of the disease to include untreated trigeminal sensory divisions.
Each of these ablative procedures can be safely repeated for recurrence, as long as the goal remains the creation of mild to moderate hypesthesia. There is no evidence to suggest that patients who have undergone a percutaneous ablative procedure are at any disadvantage should they later undergo microvascular decompression for recurrence. However, the success rate for treatment by a repeat procedure is lower than that for a primary procedure and the recurrence rate is higher.
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