Percutaneous stereotactic differential radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia

Purpose: The purpose of this study was to evaluate the effectiveness of rad iofrequency 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 eva luated for pain relief, recurrence requiring or not requiring reoperation, and the type and rate of complications. They were followed-up by serial cli nical evaluation and telephone interview. Patients were categorized into gr oups: 1) Successful result: excellent, good pain relief; and 2) Unsuccessfu l result: fair, poor, or no pain relief. The RTR group was compared with hi storical controls. Follow-up ranged from 9 to 68 months (mean, 32 months) a nd results were evaluated at early and long-term follow-up. Results: At early follow-up (defined as immediately postoperatively to 6 mo nths), pain relief of excellent or good quality (successful result) occurre d in 198 of 215 patients (92%). Fair or poor or no pain relief (unsuccessfu l result) occurred in 17 (8%) patients. At long-term follow-up (>6 months t o 68 months), recurrence of pain that required reoperation occurred in 24 p atients (11%) and recurrence of pain that did not require reoperation (medi cally managed) occurred in 34 patients (16%). Dysesthesia developed in 18 p atients (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 pa tients (1.8%) and was medically managed. At long-term follow-up, 83% of pat ients had good to excellent pain relief (successful result). There were no mortalities, no significant morbidity, and a low rate of minor complication s. Conclusion: With the use of this specific diagnostic approach and managemen t algorithm, patients with trigeminal neuralgia can be successfully managed .