Intraorbital surgery for trigeminal neuralgia.

PURPOSE: First-division trigeminal neuralgia, or tic douloureux refractory to medications, presents problems to the surgeon because of the desirability of preserving corneal sensation. A new operation is described that may provide longer duration of pain relief than conventional supraorbital neurectomy, with preservation of the corneal reflex.

METHODS

Four patients underwent resection of the supratrochlear and supraorbital nerves within the orbit accessed from an upper eyelid skin crease incision.

RESULTS

Three patients with typical idiopathic trigeminal neuralgia involving branches of the frontal nerve are without pain 22 to 25 months after surgery. The final patient with atypical pain had no improvement after the procedure. Frontal nerve distribution anesthesia is present in all patients. Postoperative ptosis resolved in all patients within 4 months of surgery.

CONCLUSIONS

This procedure should be added to the treatment options for patients with first-division trigeminal neuralgia. By avoiding injury to the trigeminal root and ganglion, this surgery carries no risk of facial motor dysfunction, dysthesia, and/or anesthesia in the other trigeminal branches including corneal anesthesia.