title: Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis.
abstract: OBJECTIVE
  Patients with trigeminal neuralgia due to multiple sclerosis (TN-MS) and idiopathic TN (ITN) who underwent glycerol rhizotomy (GR) and radiofrequency thermocoagulation with glycerol rhizotomy (RFTC-GR) were compared to investigate the effectiveness of these percutaneous ablative procedures in the TN-MS population.
  
  
  METHODS
  Between 1998 and 2010, 822 patients with typical TN were evaluated; 63 (8%) had TN-MS and 759 (92%) had ITN. Pain relief comparisons were made between 22 GR procedures in patients with TN-MS and 470 GR procedures in patients with ITN; 50 RFTC-GR procedures in patients with TN-MS and 287 RFTC-GR procedures in patients with ITN were compared. Analysis of time to recurrence included only procedures that achieved complete pain relief without medications.
  
  
  RESULTS
  After 15 of the GR procedures (68%) in patients with TN-MS and 315 of the procedures (67%) in those with ITN, the patients were pain free without medications (p = 0.736). After 36 of the RFTC-GR procedures (72%) in patients with TN-MS and 210 of the procedures (73%) in those with ITN, the patients were pain free without medications (p = 0.657). The difference in pain relief between GR and RFTC-GR for patients with TN-MS was not significant (p = 0.447). The median time to failure of GR was 20 months in patients with TN-MS compared with 25 months in those with ITN (p = 0.403). The median time to failure of RFTC-GR was 26 months in the TN-MS population compared with 21 months in the ITN population (p = 0.449). Patients with TN-MS experienced similar times to recurrence whether they were treated with GR or RFTC-GR (p = 0.431).
  
  
  CONCLUSIONS
  Pain relief and durability of relief outcomes of GR and RFTC-GR were similar in patients with TN-MS and ITN, reinforcing their use as preferred treatments of TN-MS. The GR and RFTC-GR achieved comparable outcomes in patients with TN-MS, suggesting that both can be used to good effect.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. mlim3@jhmi.edu
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bender
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pradilla
authors.forename: Sachin
authors.initials: S
authors.lastname: Batra
authors.forename: Alfred P
authors.initials: AP
authors.lastname: See
authors.forename: Carol
authors.initials: C
authors.lastname: James
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pardo
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Carson
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D004564:Electrocoagulation / Q000379:methods*; D005157:Facial Pain / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005990:Glycerol / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D019051:Rhizotomy / Q000379:methods*; D012997:Solvents / Q000627:therapeutic use; D014277:Trigeminal Neuralgia / Q000150:complications / Q000601:surgery*
chemical_list: D012997:Solvents; D005990:Glycerol