Radiofrequency thermocoagulation for trigeminal neuralgia without intra-operative patient waking

• Published in: British journal of neurosurgery 2012-06, Vol.26 (3), p.392-396
• Main Authors: Hart, Michael G., Nowell, Mark, Coakham, Hugh B.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia, General; Electrocoagulation - methods; Female; Humans; Intraoperative Care - methods; Male; Middle Aged; Neurosurgery; operative time; Pain; Pain Measurement; Pain, Postoperative - prevention & control; Patient Satisfaction; Quality of Life; questionnaire; Radio frequency; Radiosurgery - methods; Recurrence; Surgical outcomes; Surveys and Questionnaires; Treatment Outcome; Trigeminal Neuralgia - surgery; Wakefulness
• ISSN: 0268-8697; 1360-046X
• DOI: 10.3109/02688697.2012.673650

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.