Selective juxtapontine trigeminal rhizotomy: How I do it

Microvascular decompression (MVD) is the reference treatment for trigeminal neuralgia (TN) with a proven neurovascular conflict. Some patients have pharmacoresistant TN without convincing compression on MRI, or recurrence after ablative procedures. Through a keyhole retrosigmoid approach, after inspecting the trigeminal root to exclude a compressive conflict, the ventrolateral two-thirds of the pars major are selectively sectioned at the juxtapontine level, interrupting nociceptive fibres while sparing epicritic sensation and the corneal reflex. Properly indicated, selective juxtapontine rhizotomy provides durable pain relief with limited sensory morbidity.