A PROSPECTIVE 15-YEAR FOLLOW-UP OF 154 CONSECUTIVE PATIENTS WITH TRIGEMINAL NEURALGIA TREATED BY PERCUTANEOUS STEREOTAXIC RADIOFREQUENCY THERMAL RHIZOTOMY

There is a lack of prospective studies for the long-term results of pe rcutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatmen t of patients with trigeminal neuralgia. The authors present results i n 154 consecutive patients with trigeminal neuralgia treated by PSR an d prospectively followed for 15 years. Ninety-nine percent of the pati ents obtained initial pain relief after one PSR. Dysesthesia occurred in 31 patients (23%): in 7% with mild initial hypalgesia; in 15% with dense hypalgesia; and in 36% with analgesia Dysesthesia was mild and d id not require treatment in most patients. The corneal reflex was abse nt or depressed in 29 patients, and keratitis developed in three patie nts. in 19 of 22 patients with trigeminal motor weakness, the paresis resolved within 1 year. Of 33 patients who had pain recurrence, 10 pat ients had pain that was mild or controlled with medications, and 23 pa tients required additional surgical treatment. The authors estimated u sing Kaplan-Meier analysis that the 14-year recurrence rate was 25% in the total group: 60% in patients with mild hypalgesia, 25% in those w ith dense hypalgesia, and 20% in those with analgesia. Timing of pain recurrence varied according to the degree of sensory loss. All pain re currences in patients with mild hypalgesia occurred within 4 years aft er surgery, 10% more of the patients with dense hypalgesia had pain re currences within the first 10 years compared with patients with analge sia. The median pain-free survival rate was 32 months for patients wit h mild hypalgesia and more than 15 years for patients with either anal gesia or dense hypalgesia. Of the 100 patients followed for 15 years a fter one or two PSR procedures, 95 patients (95%) rated the procedure excellent (77 patients) or good (18 patients). The authors conclude th at PSR is an effective, safe treatment for trigeminal neuralgia Dense hypalgesia in the painful trigger zone, rather than analgesia, should be the target lesion.