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Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia.
Mt Sinai J Med. 2000 Sep; 67(4):288-99.MS

Abstract

BACKGROUND

Trigeminal neuralgia (TN) is the most common cephalic neuralgia in people over the age of fifty, with a mean incidence of 4 per 100,000. Percutaneous stereotactic differential radiofrequency thermal rhizotomy (RTR) is a well-recognized surgical treatment for TN. The purpose of this study was to evaluate a management algorithm for TN and to evaluate the effectiveness of RTR for TN after failure of pharmacologic management.

METHODS

Two hundred and fifty-eight (258) patients underwent RTR from 1992-1996 and were prospectively evaluated. These patients were characterized by age, sex, side of the face and division(s) involved. Patients were evaluated for pain relief, recurrence requiring or not requiring re-operation, and the type and rate of complications. They were followed by serial clinical evaluation and telephone interview. Patients were grouped according to results: (A) Successful Result--excellent or good pain relief; (B) Unsuccessful Result--fair, poor or no pain relief. The RTR group was compared to historical controls. Follow-up ranged from 12-80 months (mean = 38 months).

RESULTS

At early follow-up (defined as median postoperative period up to 6 months), pain relief that was excellent or good (successful results) occurred in 224/258 (87%). At long-term follow-up (> 6 months) recurrence of tic pain required re-operation in 31 patients (12%). In 37 patients (14%), recurrence of tic pain did not require re-operation. Dysesthesia developed in 20 patients (8%); corneal analgesia developed in 8 patients (3%). "Anesthesia dolorosa" developed in 5 patients (2%) and was medically managed. At the conclusion of the long-term follow-up period, 214/258 patients (83%) had excellent to good pain relief (successful result). There were no mortalities, no significant morbidity and a low rate of minor complications.

CONCLUSION

With the use of this specific diagnostic and management algorithm, patients with TN can be successfully managed with RTR.

Authors+Show Affiliations

Craniofacial Pain Center, and the Neurosurgical Service, Massachusetts General Hospital, Boston, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11021779

Citation

Mathews, E S., and S J. Scrivani. "Percutaneous Stereotactic Radiofrequency Thermal Rhizotomy for the Treatment of Trigeminal Neuralgia." The Mount Sinai Journal of Medicine, New York, vol. 67, no. 4, 2000, pp. 288-99.
Mathews ES, Scrivani SJ. Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. Mt Sinai J Med. 2000;67(4):288-99.
Mathews, E. S., & Scrivani, S. J. (2000). Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. The Mount Sinai Journal of Medicine, New York, 67(4), 288-99.
Mathews ES, Scrivani SJ. Percutaneous Stereotactic Radiofrequency Thermal Rhizotomy for the Treatment of Trigeminal Neuralgia. Mt Sinai J Med. 2000;67(4):288-99. PubMed PMID: 11021779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. AU - Mathews,E S, AU - Scrivani,S J, PY - 2000/10/6/pubmed PY - 2001/2/28/medline PY - 2000/10/6/entrez SP - 288 EP - 99 JF - The Mount Sinai journal of medicine, New York JO - Mt Sinai J Med VL - 67 IS - 4 N2 - BACKGROUND: Trigeminal neuralgia (TN) is the most common cephalic neuralgia in people over the age of fifty, with a mean incidence of 4 per 100,000. Percutaneous stereotactic differential radiofrequency thermal rhizotomy (RTR) is a well-recognized surgical treatment for TN. The purpose of this study was to evaluate a management algorithm for TN and to evaluate the effectiveness of RTR for TN after failure of pharmacologic management. METHODS: Two hundred and fifty-eight (258) patients underwent RTR from 1992-1996 and were prospectively evaluated. These patients were characterized by age, sex, side of the face and division(s) involved. Patients were evaluated for pain relief, recurrence requiring or not requiring re-operation, and the type and rate of complications. They were followed by serial clinical evaluation and telephone interview. Patients were grouped according to results: (A) Successful Result--excellent or good pain relief; (B) Unsuccessful Result--fair, poor or no pain relief. The RTR group was compared to historical controls. Follow-up ranged from 12-80 months (mean = 38 months). RESULTS: At early follow-up (defined as median postoperative period up to 6 months), pain relief that was excellent or good (successful results) occurred in 224/258 (87%). At long-term follow-up (> 6 months) recurrence of tic pain required re-operation in 31 patients (12%). In 37 patients (14%), recurrence of tic pain did not require re-operation. Dysesthesia developed in 20 patients (8%); corneal analgesia developed in 8 patients (3%). "Anesthesia dolorosa" developed in 5 patients (2%) and was medically managed. At the conclusion of the long-term follow-up period, 214/258 patients (83%) had excellent to good pain relief (successful result). There were no mortalities, no significant morbidity and a low rate of minor complications. CONCLUSION: With the use of this specific diagnostic and management algorithm, patients with TN can be successfully managed with RTR. SN - 0027-2507 UR - https://www.unboundmedicine.com/medline/citation/11021779/Percutaneous_stereotactic_radiofrequency_thermal_rhizotomy_for_the_treatment_of_trigeminal_neuralgia_ DB - PRIME DP - Unbound Medicine ER -