title: Management of bilateral trigeminal neuralgia with trigeminal radiofrequency rhizotomy: a treatment strategy for the life-long disease.
abstract: BACKGROUND
  The objective of this study was to evaluate the effectiveness of percutaneous controlled radiofrequency trigeminal rhizotomy (RF-TR) in patients with bilateral trigeminal neuralgia (BTN). Patients were analyzed after RF-TR in terms of outcome, safety and complications.
  
  
  METHODS
  Eighty-nine BTN patients underwent 186 RF-TR procedures. Eighty-seven patients had idiopathic trigeminal neuralgia (ITN) and two patients had multiple sclerosis (2.2%). Fifty-six (62.9%) were women and 33 (37.1%) were men. Ages ranged from 29 to 85 years. Anesthesia was administered at a determined optimal level, allowing patient cooperation for controlled and selective lesioning.
  
  
  RESULTS
  The mean follow-up period was 101.71 ± 77.7 months. Familial occurrence was seen in two (2.2%) patients. Synchronized pain was observed in 25 (28.2%) patients. Pain occurrence on the contralateral side was observed with an average duration of 124.7 ± 87.13 months. Fifty-four of the 89 patients underwent 146 RF-TR procedures for both sides and 35 underwent 40 RF-TR procedures for one side. Complete pain relief or partial satisfactory pain relief was achieved on the medically treated side in 35 patients. During follow-up, 36 patients required the second procedure and 7 required the third procedure. Acute pain relief was reported in 86 (96.6%) patients. Early (<6 months) pain recurrence was observed in 11 (12.3%) and late (>6 months) recurrence in 25 (28.0%) patients. Complications included diminished corneal reflex in four (2.1%) patients, keratitis in two (1.1%), masseter dysfunction in four (2.1%), dysesthesia in two (1.1%), and anesthesia dolorosa in one (0.5%).
  
  
  CONCLUSIONS
  RF-TR is an effective, selective, well-controlled, and effortlessly repeatable procedure for treating BTN, especially in the elderly, in terms of low morbidity and mortality rates and high rate of satisfactory pain relief.
authors.affiliation: Department of Neurosurgery, Ankara University, Faculty of Medicine, Turkey.
authors.forename: Melih
authors.initials: M
authors.lastname: Bozkurt
authors.forename: Eyyub S M
authors.initials: ES
authors.lastname: Al-Beyati
authors.forename: Mevci
authors.initials: M
authors.lastname: Ozdemir
authors.forename: Gokmen
authors.initials: G
authors.lastname: Kahilogullari
authors.forename: Atilla Halil
authors.initials: AH
authors.lastname: Elhan
authors.forename: Ali
authors.initials: A
authors.lastname: Savas
authors.forename: Yucel
authors.initials: Y
authors.lastname: Kanpolat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000150:complications / Q000601:surgery*