title: Radiofrequency thermocoagulation for trigeminal neuralgia without intra-operative patient waking.
abstract: OBJECTIVE
  It is proposed that radiofrequency thermocoagulation (RFT) under general anaesthesia without waking the patient intra-operatively, which is usually performed to confirm lesion location, will reduce the peri-operative discomfort and anxiety suffered by patients.
  
  
  METHODS
  A retrospective review of all procedures, identified through standard hospital audit codes and performed by a single surgeon from 2000 to 2007. Postal questionnaires were sent to all eligible patients. Outcome criteria included pain relief, adverse events and patients' views on satisfaction, timing and outcomes. A Kaplan-Meier plot was used to determine actuarial rates of pain relief.
  
  
  RESULTS
  Follow-up was available for 84% (37/44) of patients. Complete post-operative pain relief was 96% (42/44). The actuarial rates of complete pain relief at 6, 12, 24 and 36 months were 89%, 79%, 66% and 43%. No patients reported an outcome that did not meet their expectations while 71% (20/28) had an outcome that was better than their expectation. Serious complications included corneal numbness affecting 12% (5/41), but no cases of keratitis and a single case of anaesthesia dolorosa.
  
  
  CONCLUSIONS
  Not waking a patient intra-operatively when performing a RFT is a viable treatment option that results in excellent early pain relief, comparable to results in the literature and without an increase in complications. Patient reported outcomes indicate a high rate of satisfaction and are a novel addition to our understanding of the procedure; there is no comparable data in the literature documenting patient satisfaction outcomes when the procedure is performed with patient waking.
authors.affiliation: Academic Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital, Cambridge, UK. m.g.hart@doctors.net.uk
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hart
authors.forename: Mark
authors.initials: M
authors.lastname: Nowell
authors.forename: Hugh B
authors.initials: HB
authors.lastname: Coakham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*; D014851:Wakefulness