Percutaneous and open microsurgical techniques for relief of refractory tic douloureux.

In the younger patient with trigeminal neuralgia refractory to medical treatment, microsurgical operation is warranted. If a truly significant compressive artery is found in relation to the posterior root, microvascular decompression is carried out. If no convincing evidence of a compressive vascular lesion is found at operation, the posterior root is partially sectioned. Most patients with tic douloureux are elderly and in these, and in all patients who prefer a minor procedure, I favor the simple low morbidity percutaneous radiofrequency technique. In these days of informed consent, patients should preoperatively be made aware of the advantages of both kinds of operations and participate in choosing the procedure which best suits the individual's health and preferences.