Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia.
BACKGROUND
Trigeminal neuralgia (TN) is the most common facial pain syndrome, with an incidence of approximately 27 per 100,000 patient-years.


OBJECTIVE
To prospectively compare facial pain outcomes for patients having either a posterior fossa exploration (PFE) or stereotactic radiosurgery (SRS) as their first surgery for idiopathic TN.


METHODS
Prospective cohort study of 140 patients with idiopathic TN who had either PFE (n = 91) or SRS (n = 49) from June 2001 until September 2007. The groups were similar with regard to sex, pain location, and pain duration. Patients who had SRS were older (67.1 vs 58.2 years; P < .001). The median follow-up after surgery was 38 months.


RESULTS
Patients who had PFE more commonly were pain free off medications (84% at 1 year, 77% at 4 years) compared with the SRS patients (66% at 1 year, 56% at 4 years; hazard ratio = 2.5; 95% confidence interval, 1.4-4.6; P = .003). Additional surgery for persistent or recurrent face pain was performed in 14 patients after PFE (15%) compared with 17 patients after SRS (35%; P = .009). Nonbothersome facial numbness occurred more frequently in the SRS group (33% vs 18%; P = .04). No difference was noted in other complications between patients who had PFE (12%) (dysesthetic facial pain, n = 3; cerebrospinal fluid leakage, n = 3; hearing loss, n = 2; wound infection, n = 1; pneumonia, n = 1; deep vein thrombosis, n = 1) and patients who had SRS (8%) (dysesthetic facial pain, n = 4; P = .47).


CONCLUSIONS
PFE is more effective than SRS as a primary surgical option for patients with idiopathic TN.
Pollock
Bruce E
BE
Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. pollock.bruce@mayo.edu
Schoeberl
Kimberly A
KA
D000368:Aged; D015331:Cohort Studies; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D014276:Trigeminal Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*