A nationwide study of three invasive treatments for trigeminal neuralgia.
Invasive procedures for treatment of trigeminal neuralgia (TGN) include percutaneous radiofrequency thermocoagulation (PRT), partial sensory rhizotomy (PSR), and microvascular decompression (MVD). Using a nationwide discharge registry from The Netherlands, we assessed the frequency of use and patient characteristics, and evaluated treatment failure for each patient undergoing PRT, PSR, or MVD from January 2002 through December 2004. Only patients without a procedure in the year prior were included. Primary outcome was readmission for repeat procedures for TGN or known complications within 1year. Comparability of patient populations was assessed through propensity scores based on hospital, age, sex, and comorbidity. Conditional logistic regression matched on propensity score was used to calculate relative risks (RR) with 95% confidence intervals (CIs) for repeat procedures or complications. During the study period, 672 patients with TGN underwent PRT, 39 underwent PSR, and 87 underwent MVD. Hospital type was the predominant determinant of procedure type; age, sex, and comorbidity were weak predictors. The RR for repeat procedures for PSR was 0.21 (95% CI: 0.07 to 0.65) and for MVD was 0.13 (95% CI: 0.05 to 0.35) compared with PRT (RR 1). For complications, the RR of PSR was 5.36 (95% CI: 1.46 to 19.64) and of MVD was 4.40 (95% CI: 1.44 to 13.42). Sex, urbanization, and comorbidity did not influence prognosis, but hospital and surgical volume did. In conclusion, although PSR and MVD are associated with a lower risk of repeat procedure than PRT, they seem to be more prone to complications requiring hospital readmission. Microvascular decompression and partial sensory rhizotomy are associated with a lower risk of undergoing a repeat procedure compared with percutaneous radiofrequency thermocoagulation but are more prone to complications requiring readmission to hospital.
Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pharmaceutical Affairs and Medical Technology, Health Care Inspectorate, The Hague, The Netherlands Department of Pain Treatment, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Joseph S H A
JSHA
Koopman
Laura M
LM
de Vries
Jeanne P
JP
Dieleman
Frank J
FJ
Huygen
Bruno H Ch
BHC
Stricker
Miriam C J M
MCJM
Sturkenboom
D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D019051:Rhizotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000453:epidemiology / Q000628:therapy*
Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077-1083.
Broggi G, Ferroli P, Franzini A. Treatment strategy for trigeminal neuralgia: a thirty years experience. Neurol Sci. 2008;29:S79-82.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373-383.
Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15:1013-1028.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613-619.
Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183-1190.
Jannetta PJ. Neurovascular compression in cranial nerve and systemic disease. Ann Surg. 1980;192:518-525.
Jannetta PJ. Microsurgical management of trigeminal neuralgia. Arch Neurol. 1985;42:800.
Kabatas S, Albayrak SB, Cansever T, Hepgul KT. Microvascular decompression as a surgical management for trigeminal neuralgia: a critical review of the literature. Neurol India. 2009;57:134-138.
Kolluri S, Heros RC. Microvascular decompression for trigeminal neuralgia. A five-year follow-up study. Surg Neurol. 1984;22:235-240.
Koopman JS, Dieleman JP, Huygen FJ, de Mos M, Martin CG, Sturkenboom MC. Incidence of facial pain in the general population. Pain. 2009;147:122-127.
Krafft RM. Trigeminal neuralgia. Am Fam Physician. 2008;77:1291-1296.
Kupka K. International classification of diseases: 9th revision. WHO Chronicle. 1978;32:219-225.
Laghmari M, El Ouahabi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia? Surg Neurol. 2007;68:505-512.
Linskey ME, Jho HD, Jannetta PJ. Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar compression. J Neurosurg. 1994;81:1-9.
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg. 1999;90:1-8.
Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127:757-763.
Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10:585-598.
Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007;107:1144-1153.
Sjaastad O, Bakketeig LS. The rare, unilateral headaches. Vaga study of headache epidemiology. J Headache Pain. 2007;8:19-27.
Spatz AL, Zakrzewska JM, Kay EJ. Decision analysis of medical and surgical treatments for trigeminal neuralgia: how patient evaluations of benefits and risks affect the utility of treatment decisions. Pain. 2007;131:302-310.
Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia. J Neurosurg. 1974;40:143-156.
Taha JM, Tew JM Jr, Buncher CR. A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg. 1995;83:989-993.
Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien). 2008;150:243-255.
Toda K. Operative treatment of trigeminal neuralgia: review of current techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:788-805.
Voros E, Palko A, Horvath K, Barzo P, Kardos L, Kuncz A. Three-dimensional time-of-flight MR angiography in trigeminal neuralgia on a 0.5-T system. Eur Radiol. 2001;11:642-647.
Young JN, Wilkins RH. Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia. J Neurosurg. 1993;79:680-687.