Some considerations about the treatment of trigeminal neuralgia with intrathecal baclofen

A case history of therapy resistent trigeminal neuralgia was presented by Wechsung and Müller. This patient was previously treated without any succes with glycerol injections, "electrocauterisation", a Janetta operation and 2 reexplorations of the posterior fossa. Attempts with oral carbamazepine and baclofen were unsuccesful too. The authors did not try out the combination of carbamazepine and baclofen, which is recommended by Fromm and Terrence. When conservative treatment fails, surgical procedures are indicated. The most succesful surgical procedure is the radiofrequency thermal lesion of the Gasserian ganglion (Sweet). Data from the literature from 8500 patients and own data (from over 600 patients) show that therapy resistance is very infrequent (0.5%). The costs of clinical implantation of a pump with intrathecally administered baclofen are 10-15 times higher than ambulant radiofrequency lesioning.