Treatment of trigeminal neuralgia in the aged by a simplified surgical approach (percutaneous electrocoagulation).
Trigeminal neuralgia can be excruciatingly painful. For aged patients, among whom trigeminal neuralgia most commonly occurs, medical therapy may often afford relief of pain. However, since this disorder is likely to become worse with increasing age, medical therapy eventually may fail because of increasing drug requirements and intolerable side effects. Major forms of surgical treatment requiring craniotomy may afford longstanding relief but are associated with significant side effects in 3-5 per cent of cases. For these reasons the authors began to test a new surgical approach, i.e., stereotaxic percutaneous electrocoagulation of the trigeminal nerve. More than 300 patients have been treated by this technique in the past five years. Successive radiofrequency lesions allow the production of a graded sensory deficit sufficient to relieve pain while preserving touch and motor function in the face. Unnecessary suffering from the severe pain of trigeminal neuralgia need not occur because of age or a debilitated condition which might ordinarily preclude surgical treatment. More than 100 patients over 65 years of age (4 of them older than 90) have been treated. Of this group, 93 per cent reported good to excellent results. Seven per cent have had some recurrent pain during the follow-up period; however, recoagulation has been required in only 5 per cent of these patients. Recoagulation may be readily performed in any patient who shows evidence of fading of the sensory deficit. The electrocoagulation technique and the results in elderly patients are discussed.
D000368:Aged; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009339:Needles; D013238:Stereotaxic Techniques / Q000009:adverse effects; D014276:Trigeminal Nerve / Q000473:pathology; D014277:Trigeminal Neuralgia / Q000601:surgery*