Acta Neurochirurgica (2026) 168:42
This single-center retrospective analysis reports outcomes of partial sensory rhizotomy (PSR) for therapy-refractory or recurrent trigeminal neuralgia (TN) in 48 patients treated between 2004 and 2023. The study details patient selection, surgical technique, and perioperative findings, noting immediate pain relief in most patients, variable hypesthesia, and acceptable complication rates without permanent deficits.
Long-term follow-up (mean 38 months) found 65% pain-free without medication and 95% overall satisfaction (BNI 1–3), including a substantive subset with multiple sclerosis; recurrence occurred in 27% with some successfully re-operated. The authors conclude PSR is a viable option for selected refractory or recurrent TN patients, emphasizing informed consent about unpredictable sensory deficits
Partial Sensory Rhizotomy (PSR) Role: PSR is a surgical option for therapy-refractory or recurrent trigeminal neuralgia (TN), especially in patients without neurovascular conflict or those who failed previous microvascular decompression (MVD) or other interventions.
Efficacy: PSR provided immediate total pain relief in 87.5% (42/48) of patients; long-term, 72.1% (31/43) had complete or partial pain relief without medication, and 23.3% were satisfied with ongoing medication.
Indications: PSR is particularly relevant for patients with multiple sclerosis (MS)-related TN and those without a clear neurovascular conflict, as well as for those not responding to or preferring to avoid repeated percutaneous or radiosurgical procedures.
Complications: Postoperative hypesthesia is expected and occurred in 77.1% of patients, but was generally well tolerated; no cases of anesthesia dolorosa or corneal anesthesia were observed. Other complications (e.g., CSF fistula, transient hearing impairment) were rare and resolved with treatment.
Recurrence: The observed recurrence rate after PSR was 27.1%, consistent with previously reported rates (10–49% over five years), and repeat PSR was effective in patients with recurrent pain.
Comparison with Other Treatments: While MVD is preferred when neurovascular conflict is present, PSR offers comparable long-term pain relief in selected patients, but with a higher risk of sensory deficits. Combined MVD+PSR does not improve long-term outcomes if no vascular conflict exists.
Patient Satisfaction: Overall, 95% of patients reported meaningful improvement and satisfaction with PSR, despite sensory deficits, when adequately counseled preoperatively.
Recommendation: PSR should be considered and discussed as a viable surgical alternative for therapy-refractory or recurrent TN, particularly in MS patients and those not suitable for or preferring to avoid other invasive procedures.
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