title: Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. pollock.bruce@mayo.edu
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Pollock
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Schoeberl
mesh_terms: 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*