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Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia.
J Oral Maxillofac Surg. 1999 Feb; 57(2):104-11; discussion 111-2.JO

Abstract

PURPOSE

The purpose of this study was to evaluate the effectiveness of radiofrequency thermal rhizotomy (RTR) for trigeminal neuralgia, after failure of pharmacological management.

PATIENTS AND METHODS

Two hundred fifteen patients underwent RTR from 1991 to 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 reoperation, and the type and rate of complications. They were followed-up by serial clinical evaluation and telephone interview. Patients were categorized into groups: 1) Successful result: excellent, good pain relief; and 2) Unsuccessful result: fair, poor, or no pain relief. The RTR group was compared with historical controls. Follow-up ranged from 9 to 68 months (mean, 32 months) and results were evaluated at early and long-term follow-up.

RESULTS

At early follow-up (defined as immediately postoperatively to 6 months), pain relief of excellent or good quality (successful result) occurred in 198 of 215 patients (92%). Fair or poor or no pain relief (unsuccessful result) occurred in 17 (8%) patients. At long-term follow-up (>6 months to 68 months), recurrence of pain that required reoperation occurred in 24 patients (11%) and recurrence of pain that did not require reoperation (medically managed) occurred in 34 patients (16%). Dysesthesia developed in 18 patients (8%); seven patients (3%) had dysesthesia alone (medically managed) and 11 patients (5%) had dysesthesia with recurrence of pain (medically or surgically managed). "Anesthesia/analgesia dolorosa" developed in four patients (1.8%) and was medically managed. At long-term follow-up, 83% of patients had good to excellent 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 approach and management algorithm, patients with trigeminal neuralgia can be successfully managed.

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Publisher Full Text

Authors+Show Affiliations

Scrivani SJ
Department of Oral and Maxillofacial Surgery, The Craniofacial Pain Center, Massachusetts General Hospital, Boston 02114, USA.
Keith DA
No affiliation info available
Mathews ES
No affiliation info available
Kaban LB
No affiliation info available

MeSH

AdultAgedAged, 80 and overAlgorithmsFemaleFollow-Up StudiesHumansInterviews as TopicLongitudinal StudiesMaleMiddle AgedProspective StudiesRadiosurgeryRecurrenceReoperationRhizotomySensation DisordersTreatment OutcomeTrigeminal Neuralgia

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

9973115

Citation

Scrivani, S J., et al. "Percutaneous Stereotactic Differential Radiofrequency Thermal Rhizotomy for the Treatment of Trigeminal Neuralgia." Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, vol. 57, no. 2, 1999, pp. 104-11; discussion 111-2.
Scrivani SJ, Keith DA, Mathews ES, et al. Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. J Oral Maxillofac Surg. 1999;57(2):104-11; discussion 111-2.
Scrivani, S. J., Keith, D. A., Mathews, E. S., & Kaban, L. B. (1999). Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 57(2), 104-11; discussion 111-2.
Scrivani SJ, et al. Percutaneous Stereotactic Differential Radiofrequency Thermal Rhizotomy for the Treatment of Trigeminal Neuralgia. J Oral Maxillofac Surg. 1999;57(2):104-11; discussion 111-2. PubMed PMID: 9973115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. AU - Scrivani,S J, AU - Keith,D A, AU - Mathews,E S, AU - Kaban,L B, PY - 1999/2/11/pubmed PY - 1999/2/11/medline PY - 1999/2/11/entrez SP - 104-11; discussion 111-2 JF - Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons JO - J Oral Maxillofac Surg VL - 57 IS - 2 N2 - PURPOSE: The purpose of this study was to evaluate the effectiveness of radiofrequency thermal rhizotomy (RTR) for trigeminal neuralgia, after failure of pharmacological management. PATIENTS AND METHODS: Two hundred fifteen patients underwent RTR from 1991 to 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 reoperation, and the type and rate of complications. They were followed-up by serial clinical evaluation and telephone interview. Patients were categorized into groups: 1) Successful result: excellent, good pain relief; and 2) Unsuccessful result: fair, poor, or no pain relief. The RTR group was compared with historical controls. Follow-up ranged from 9 to 68 months (mean, 32 months) and results were evaluated at early and long-term follow-up. RESULTS: At early follow-up (defined as immediately postoperatively to 6 months), pain relief of excellent or good quality (successful result) occurred in 198 of 215 patients (92%). Fair or poor or no pain relief (unsuccessful result) occurred in 17 (8%) patients. At long-term follow-up (>6 months to 68 months), recurrence of pain that required reoperation occurred in 24 patients (11%) and recurrence of pain that did not require reoperation (medically managed) occurred in 34 patients (16%). Dysesthesia developed in 18 patients (8%); seven patients (3%) had dysesthesia alone (medically managed) and 11 patients (5%) had dysesthesia with recurrence of pain (medically or surgically managed). "Anesthesia/analgesia dolorosa" developed in four patients (1.8%) and was medically managed. At long-term follow-up, 83% of patients had good to excellent 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 approach and management algorithm, patients with trigeminal neuralgia can be successfully managed. SN - 0278-2391 UR - https://www.unboundmedicine.com/medline/citation/9973115/Percutaneous_stereotactic_differential_radiofrequency_thermal_rhizotomy_for_the_treatment_of_trigeminal_neuralgia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-2391(99)90218-5 DB - PRIME DP - Unbound Medicine ER -