[The value of destructive surgery of the trigeminal nerve in atypical facial pain].

Interruption of trigeminal pathways still is a common treatment in trigeminal neuralgia and has also been suggested for atypical facial pain. The published results in the latter group are rather poor since only 17 to 24% of these patients were free from pain after surgery. There is no information on the outcome of those patients classified as "poor results". We had the opportunity of seeing 48 patients who had been treated without success elsewhere. Pain occurred in most cases after ETN or dental operations. 36 patients underwent, despite poor results after a first neurosurgical intervention, further (up to five) operations. In 58% a postoperative deterioration occurred mainly consisting of anaesthesia dolorosa. Suicidal attempts were four times more frequent than in the group of those patients who had merely not benefited from surgery. In conclusion, the poor results of trigeminal surgery reported in literature and the considerably high risk of postoperative deterioration, as shown in our series, prompt us to warn against destructive trigeminal surgery in atypical facial pain.