Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia.
OBJECTIVE
The purpose of this study was to evaluate the effectiveness of radiofrequency thermal rhizotomy (RTR) for trigeminal neuralgia, after failure of pharmacological management.


METHODS
Two hundred fifteen patients underwent RTR from 1991 to 1996 and were prospectively evaluated. These patients were characterized by age, sex, side of the face, and division(s) involved. Patients were evaluated for pain relief, recurrence requiring or not requiring reoperation, and the type and rate of complications. They were followed-up by serial clinical evaluation and telephone interview. Patients were categorized into groups: 1) Successful result: excellent, good pain relief; and 2) Unsuccessful result: fair, poor, or no pain relief. The RTR group was compared with historical controls. Follow-up ranged from 9 to 68 months (mean, 32 months) and results were evaluated at early and long-term follow-up.


RESULTS
At early follow-up (defined as immediately postoperatively to 6 months), pain relief of excellent or good quality (successful result) occurred in 198 of 215 patients (92%). Fair or poor or no pain relief (unsuccessful result) occurred in 17 (8%) patients. At long-term follow-up (>6 months to 68 months), recurrence of pain that required reoperation occurred in 24 patients (11%) and recurrence of pain that did not require reoperation (medically managed) occurred in 34 patients (16%). Dysesthesia developed in 18 patients (8%); seven patients (3%) had dysesthesia alone (medically managed) and 11 patients (5%) had dysesthesia with recurrence of pain (medically or surgically managed). "Anesthesia/analgesia dolorosa" developed in four patients (1.8%) and was medically managed. At long-term follow-up, 83% of patients had good to excellent pain relief (successful result). There were no mortalities, no significant morbidity, and a low rate of minor complications.


CONCLUSIONS
With the use of this specific diagnostic approach and management algorithm, patients with trigeminal neuralgia can be successfully managed.
Scrivani
S J
SJ
Department of Oral and Maxillofacial Surgery, The Craniofacial Pain Center, Massachusetts General Hospital, Boston 02114, USA.
Keith
D A
DA
Mathews
E S
ES
Kaban
L B
LB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects; D012008:Recurrence; D012086:Reoperation; D019051:Rhizotomy / Q000009:adverse effects; D012678:Sensation Disorders / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000145:classification / Q000188:drug therapy / Q000601:surgery*