Management of bilateral trigeminal neuralgia with trigeminal radiofrequency rhizotomy: a treatment strategy for the life-long disease

• Published in: Acta neurochirurgica 2012-05, Vol.154 (5), p.785-792
• Main Authors: Bozkurt, Melih, Al-Beyati, Eyyub S. M., Ozdemir, Mevci, Kahilogullari, Gokmen, Elhan, Atilla Halil, Savas, Ali, Kanpolat, Yucel
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Anesthesia; Chronic Disease; Clinical Article; Cooperation; Cornea; Female; Follow-Up Studies; Geriatrics; Humans; Interventional Radiology; Keratitis; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Morbidity; Mortality; Multiple sclerosis; Neuralgia; Neurology; Neuroradiology; Neurosurgery; Pain; Pain - etiology; Postoperative Complications - epidemiology; Reflexes; Rhizotomy - adverse effects; Rhizotomy - methods; Secondary Prevention; Surgical Orthopedics; Treatment Outcome; Trigeminal Neuralgia - complications; Trigeminal Neuralgia - surgery
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-012-1311-7

Background The objective of this study was to evaluate the effectiveness of percutaneous controlled radiofrequency trigeminal rhizotomy (RF-TR) in patients with bilateral trigeminal neuralgia (BTN). Patients were analyzed after RF-TR in terms of outcome, safety and complications. Methods Eighty-nine BTN patients underwent 186 RF-TR procedures. Eighty-seven patients had idiopathic trigeminal neuralgia (ITN) and two patients had multiple sclerosis (2.2%). Fifty-six (62.9%) were women and 33 (37.1%) were men. Ages ranged from 29 to 85 years. Anesthesia was administered at a determined optimal level, allowing patient cooperation for controlled and selective lesioning. Results The mean follow-up period was 101.71 ± 77.7 months. Familial occurrence was seen in two (2.2%) patients. Synchronized pain was observed in 25 (28.2%) patients. Pain occurrence on the contralateral side was observed with an average duration of 124.7 ± 87.13 months. Fifty-four of the 89 patients underwent 146 RF-TR procedures for both sides and 35 underwent 40 RF-TR procedures for one side. Complete pain relief or partial satisfactory pain relief was achieved on the medically treated side in 35 patients. During follow-up, 36 patients required the second procedure and 7 required the third procedure. Acute pain relief was reported in 86 (96.6%) patients. Early (6 months) recurrence in 25 (28.0%) patients. Complications included diminished corneal reflex in four (2.1%) patients, keratitis in two (1.1%), masseter dysfunction in four (2.1%), dysesthesia in two (1.1%), and anesthesia dolorosa in one (0.5%). Conclusions RF-TR is an effective, selective, well-controlled, and effortlessly repeatable procedure for treating BTN, especially in the elderly, in terms of low morbidity and mortality rates and high rate of satisfactory pain relief.