title: Practice patterns of in-hospital surgical treatment of trigeminal neuralgia from 1988 to 2010.
abstract: OBJECTIVE
  Neurosurgeons have a variety of procedures to offer when treating medically intractable trigeminal neuralgia (TN). We reviewed the national trends in procedural volume for in-hospital treatment of TN.
  
  
  METHODS
  The Nationwide Inpatient Sample (1988-2010) provided data on patients hospitalized with a principal diagnosis of TN and a related principal procedure. We categorized principal procedures as open, other, percutaneous, or radiosurgery.
  
  
  RESULTS
  We identified 13,466 relevant hospital admissions. The volume for open procedures and radiosurgery remained relatively constant, whereas percutaneous procedures decreased. Mean age of patients undergoing percutaneous and radiosurgery procedures (67.9 and 69.5 years) was higher than open and other procedures (60.4 and 63.4 years) (p-value <0.001). The mean total in-hospital inflation-adjusted charges for all four categories increased over time (p-values <0.001). The mean total in-hospital inflation-adjusted charge for radiosurgery ($37,666) was higher than open ($28,046) procedures (p-value <0.001).
  
  
  CONCLUSIONS
  Patients who undergo an open procedure to treat TN are younger than those who undergo a percutaneous or a radiosurgery procedure. The perceived risk of open surgery in older patients may drive offering percutaneous or radiosurgical procedures. In addition, the in-hospital inflation-adjusted charges for all procedures increased over time, with radiosurgery being higher than those of open procedures.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, USA; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA. Electronic address: rosenbb@ccf.org.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Rosenbaum
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kelly
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, USA.
authors.forename: Varun R
authors.initials: VR
authors.lastname: Kshettry
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, USA.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Vadera
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D016634:Radiosurgery / Q000706:statistics & numerical data / Q000639:trends; D014277:Trigeminal Neuralgia / Q000453:epidemiology / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Nationwide Inpatient Sample; Percutaneous; Radiosurgery; Tic douloureux