Clinical Experience of “Nerve Combing”for Refractory Trigeminal Neuralgia

Five patients with idiopathic trigeminal neuralgia causing recurrent or non‒resolved pain after micro-vascular decompression and intolerance to carbamazepine were subsequently treated with nerve combing of the sensory root of the trigeminal nerve. The pain disappeared immediately after the operation without carbamazepine in all patients, but sensory disturbance persisted with a central focus on the third division of the trigeminal nerve in four of the five patients（80％）. No patient experienced any recurrent pain with good quality of life one to five years after nerve combing. Nerve combing may be an effective treatment for patients with recurrent trigeminal neuralgia without obvious offending vessels or pain refractory to carbamazepine. However, patients indicated for nerve combing should be aware of the high incidence of facial sensory disturbances after surgery.