Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients

OBJECTIVE: The objective of this study was to evaluate the effectiveness of percutaneous, controlled radiofrequency trigeminal rhizotomy (RF-TR). The outcome of 1600 patients with idiopathic trigeminal neuralgia after RF-TR w as analyzed after a follow-up period of 1 to 25 years. METHODS: A total of 1600 patients with idiopathic trigeminal neuralgia unde rwent 2138 percutaneous radiofrequency rhizotomy procedures between 1974 an d 1999. Sixty-seven patients had bilateral idiopathic trigeminal neuralgia, and 36 of them were treated with bilateral RF-TR; 1216 patients (76%) were successfully managed with a single procedure, and the remainder were treat ed with multiple procedures. Benzodiazepines and narcotic analgesics were u sed for anesthesia because patient cooperation during the procedures was es sential so that the physician could create selective, controlled lesions. RESULTS: The average follow-up time was 68.1 +/- 66.4 months (range, 12-300 mo). Acute pain relief was accomplished in 97.6% of patients. Complete pai n relief was achieved at 5 years in 57.7% of the patients who underwent a s ingle procedure. Pain relief was reported in 92% of patients with a single procedure or with multiple procedures 5 years after the first rhizotomy was performed. At 10-year follow-up, 52.3% of the patients who underwent a sin gle procedure and 94.2% of the patients who underwent multiple procedures h ad experienced pain relief; at 20-year follow-up, 41 and 100% of these pati ents, respectively, had experienced pain relief. No mortalities occurred. A fter the first procedure was performed, early pain recurrence (<6 mo) was o bserved in 123 patients (7.7%) and late pain recurrence was observed in 278 patients (17.4%). Complications included diminished corneal reflex in 91 p atients (5.7%), masseter weakness and paralysis in 66 (4.1%), dysesthesia i n 16 (1%), anesthesia dolorosa in 12 (0.8%), keratitis in 10 (0.6%), and tr ansient paralysis of Cranial Nerves III and VI in 12 (0.8%). Permanent Cran ial Nerve VI palsy was observed in two patients, cerebrospinal fluid leakag e in two, carotid-cavernous fistula in one, and aseptic meningitis in one. CONCLUSION: Percutaneous, controlled RF-TR represents a minimally invasive, low-risk technique with a high rate of efficacy. The procedure may safely be repeated if pain recurs.