Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia

Background: Trigeminal neuralgia (TN) is the most common cephalic neuralgia in people over the age of fifty, with a mean incidence of 4 per 100,000. P ercutaneous stereotactic differential radiofrequency thermal rhizotomy (RTR ) is a well-recognized surgical treatment for TN. The purpose of this study was to evaluate a management algorithm for TN and to evaluate the effectiv eness of RTR for TN after failure of pharmacologic management. Methods: Two hundred and fifty-eight (258) patients underwent RTR from 1991 -1996 and were prospectively evaluated. These patients were characterized b y age, sex, side of the face and division(s) involved. Patients were evalua ted for pain relief, recurrence requiring or not requiring re-operation, an d the type and rate of complications. They were followed by serial clinical evaluation and telephone interview. Patients were grouped according to res ults: (A) Successful Result - excellent or good pain relief; (B) Unsuccessf ul Result - fair, poor or no pain relief. The RTR group was compared to his torical controls. Follow-up ranged from 12-80 months (mean = 38 months). Results: At early follow-up (defined as median postoperative period up to 6 months), pain relief that was excellent or good (successful results) occur red in 224/258 (87%). At long-term follow-up (> 6 months) recurrence of tic pain required re-operation in 31 patients (12%). In 37 patients (14%), rec urrence of tic pain did not require re-operation. Dysesthesia developed in 20 patients (8%); corneal analgesia developed in 8 patients (3%). "Anesthes ia dolorosa" developed in 5 patients (2%) and was medically managed. At the conclusion of the long-term follow-up period, 214/258 patients (83%) had e xcellent to good 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 and management algorit hm, patients with TN can be successfully managed with RTR.