Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia.

PURPOSE: To explore an effective surgical treatment for pain in the distribution area of the maxillary branch of trigeminal nerve (TN).

MATERIALS AND METHODS: Twenty-six patients with pain in the distribution of the maxillary branch of TN were followed up after they had undergone pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route.

RESULTS: In all cases, the pain initially resolved after operation, with anaesthesia or paraesthesia in the operated side of the maxillary nerve-distributed area. After a mean follow-up period of 24 (range 3-36) months, 19 (73.08%) of the 26 patients had an excellent response, 5 (19.23%) had a good response, 2 (7.69%) had a fair response, and none (0%) had a poor response. One patient had a recurrence with palatal pain 3 months after the operation.

CONCLUSIONS: The maxillary sinus route can provide a clear vision for sectioning of the maxillary nerve. This new surgical technique has proven to be safe and effective. It provides another option for the weak elderly who are intolerant of craniotomy or patients who have contraindications for craniotomy when radiofrequency thermocoagulation (RFT) and percutaneous glycerol neurolysis (PGR) treatment is not possible.