Trigeminal nerve internal neurolysis for the treatment of trigeminal neuralgia: a systematic review
Maria Fernanda Feltrin de Oliveira, Paulo Henrique Pires de Aguiar
Abstract
Internal Neurolysis (IN) is an option to treat recurrent trigeminal neuralgia (TN) or TN lacking neurovascular compression (NVC). This study aimed to investigate the efficacy of IN in TN. A systematic review was conducted following PRISMA guidelines. Five databases were searched and ten studies were included. IN, alone or with microvascular decompression (MVD), achieves high immediate post-operative (PO) pain relief, especially in NVC-free patients and revision surgeries. Five studies examining IN alone reported immediate PO relief of up to 100%. This high initial success is tempered by rising recurrence over time. One long-term study reported decline to 47% pain-free survival at five-year mark. Furthermore, MVD plus IN approach yielded higher success rates compared to MVD alone. While IN demonstrates initial efficacy, its long-term durability is limited. Sensory complications are common immediately post-surgery, and, although studies report gradual improvement, procedure cost-effectiveness requires patient counselling. History of previous surgery for TN was identified as a poor prognostic factor for sustained success. IN is a valuable treatment for TN patients without NVC or prior treatment failure. Benefit of more efficient pain control must be carefully discussed against the possibility of sensory side effects and recurrence.
Keywords
References
1. Jati E, Iswarini A, Nugrahanto A, Prabowo Y. Complex management of pain in trigeminal neuralgia: a meta analysis. Polski Przegląd Otorynolaryngologiczny. 2025;14(2):1-5. https://doi.org/10.5604/01.3001.0055.0600.
2. Ashina S, Robertson CE, Srikiatkhachorn A, et al. Trigeminal neuralgia. Nat Rev Dis Primers. 2024;10(1):39. https://doi.org/10.1038/s41572-024-00523-z. PMid:38816415.
3. Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal neuralgia: diagnosis and treatment. Neurol Clin. 2023;41(1):107-21. https://doi.org/10.1016/j.ncl.2022.09.001. PMid:36400550.
4. Punyani SR, Jasuja VR. Trigeminal neuralgia: an insight into the current treatment modalities. J Oral Biol Craniofac Res. 2012;2(3):188-97. https://doi.org/10.1016/j.jobcr.2012.10.002. PMid:25737864.
5. Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev. 2011;2011(9):CD007312. https://doi.org/10.1002/14651858.CD007312.pub2. PMid:21901707.
6. Sabourin V, Lavergne P, Mazza J, et al. Internal neurolysis for the treatment of trigeminal neuralgia: a systematic review. World Neurosurg. 2022;158:829-42. https://doi.org/10.1016/j.wneu.2021.11.068. PMid:34823039.
7. Pines AR, Butterfield RJ, Turcotte EL, et al. Microvascular transposition without teflon: a single institution’s 17-year experience treating trigeminal neuralgia. Oper Neurosurg. 2021;20(4):397-405. https://doi.org/10.1093/ons/opaa413. PMid:33432975.
8. Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ. Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg. 2015;122(5):1048-57. https://doi.org/10.3171/2014.12.JNS14469. PMid:25679283.
9. Zheng W, Dong X, Wang D, Hu Q, Du Q. Long time efficacy and safety of microvascular decompression combined with internal neurolysis for recurrent trigeminal neuralgia. J Korean Neurosurg Soc. 2021;64(6):966-74. https://doi.org/10.3340/jkns.2020.0315. PMid:34689474.
10. Lavergne P, Piper K, Vinjamuri S, Kelly P, Evans JJ. Internal neurolysis for trigeminal neuralgia: technical nuances and a single-institution experience. World Neurosurg. 2024;184:e9-16. https://doi.org/10.1016/j.wneu.2023.08.126. PMid:37666299.
11. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71. https://doi.org/10.1136/bmj.n71. PMid:33782057.
12. Liu MX, Zhong J, Xia L, Dou NN, Shi J. Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique. J Neurol Surg B Skull Base. 2021;82(3, Suppl 3):e295-9. https://doi.org/10.1055/s-0040-1710520. PMid:34306952.
13. Zhou X, Liu Y, Yue Z, Luan D, Zhang H, Han J. Comparação entre neurólise interna e termocoagulação percutânea por radiofrequência no tratamento da neuralgia idiopática do trigêmeo. Braz J Otorhinolaryngol. 2016;82(5):574-9. https://doi.org/10.1016/j.bjorl.2015.11.006. PMid:26832635.
14. Amagasaki K, Tatebayashi K, Naemura K. Internal neurolysis for trigeminal neuralgia: a preliminary single-institution experience in Japan. Neurol Med Chir (Tokyo). 2024;64(7):261-5. https://doi.org/10.2176/jns-nmc.2023-0285. PMid:38839296.
15. Zhao H, Zhang X, Tang D, Li S. Nerve combing for trigeminal neuralgia without vascular compression. J Craniofac Surg. 2017;28(1):e15-e17. https://doi.org/10.1097/SCS.0000000000003161. PMid:27875506.
16. Liu J, Wu G, Jiang Y, Li L, Wang D, Liu R. Relationship between arterial blood pressure during trigeminal nerve combing and surgical outcome in patients with trigeminal neuralgia. World Neurosurg. 2020;137:e98-105. https://doi.org/10.1016/j.wneu.2020.01.038. PMid:31954896.
17. Zhang X, Xu L, Zhao H, et al. Long-term efficacy of nerve combing for patients with trigeminal neuralgia and failed prior microvascular decompression. World Neurosurg. 2017;108:711-5. https://doi.org/10.1016/j.wneu.2017.09.081. PMid:28943423.
18. Zhang Z, Wang W, Yu F, Kwok SC, Wang Y, Yin J. Strategies for intraoperative management of the trigeminal nerve and long-term follow-up outcomes in patients with trigeminal neuralgia secondary to an intracranial epidermoid cyst. Front Surg. 2022;9:930261. https://doi.org/10.3389/fsurg.2022.930261. PMid:35965867.
19. Yang DB, Wang ZM. The efficacy and safety of nerve combing for trigeminal neuralgia without neurovascular compression. Acta Neurol Belg. 2019;119(3):439-44. https://doi.org/10.1007/s13760-019-01099-2. PMid:30838601.
20. Mazza J, Sabourin V, Head J, et al. Defining the complication landscape of internal neurolysis for the treatment of trigeminal neuralgia via a systematic review of the literature. J Neurol Surg B Skull Base. 2020;81(1):P056. https://doi.org/10.1055/s-0040-1702602.
21. Sabourin V, Mazza J, Garzon T, et al. Internal neurolysis with and without microvascular decompression for trigeminal neuralgia: case series. World Neurosurg. 2020;143:e70-7. https://doi.org/10.1016/j.wneu.2020.06.206. PMid:32673802.
22. Zheng W, Dong X, Wang D, Hu Q, Du Q. Long time efficacy and safety of microvascular decompression combined with internal neurolysis for recurrent trigeminal neuralgia. J Korean Neurosurg Soc. 2021;64(6): 966-74. https://doi.org/10.3340/jkns.2020.0315. PMid:34689474.
23. Wu M, Jiang X, Niu C, Fu X. Outcome of internal neurolysis for trigeminal neuralgia without neurovascular compression and its relationship with intraoperative trigeminocardiac reflex. Stereotact Funct Neurosurg. 2018;96(5):305-10. https://doi.org/10.1159/000493547. PMid:30404100.
Submitted date:
02/24/2026
Accepted date:
03/22/2026
Publication date:
05/04/2026
Facebook
LinkedIn
Mendeley
Reddit
Email