357 Postoperative Outcomes and Decreases in Pain Medication Utilization Following Nucleus Caudalis DREZ Lesioning for Painful Trigeminal Neuropathy: A Case Series

Abstract

INTRODUCTION: Painful trigeminal neuropathy is characterized by treatment-resistant trigeminal pain. Nucleus Caudalis Dorsal Root Entry Zone lesioning (NC-DREZ) has been utilized to treat this condition, but changes in medication utilization has not been studied in this population. METHODS: We retrospectively reviewed patients who underwent NC-DREZ at an academic medical center for the treatment of painful trigeminal neuropathy between March 2014 and December 2022, with a minimum 30-day follow-up. Postoperative complications, emergency department visits, readmissions, reoperations, changes in patients' subjective pain, and the longitudinal dosage of pain medications were collected as outcomes. The Fisher's exact and Kruskal-Wallis tests, with alpha set at 0.05, were used to compare the proportion and doses of medications used at each timepoint. RESULTS: Thirty-nine patients were included (mean age 55.7 years, 66.7% female) Prior interventions included trigeminal ablation (35.9%), microvascular decompression (59.0%), and stereotactic radiosurgery (41.0%).Twelve patients (30.8%) had postoperative complications, including five with transient ataxia and two with pseudomeningocele. Nine patients (23.1%) visited the ED after surgery, and 7 (17.9%) were readmitted. The rate of opioid use decreased from 56.4% at baseline to 32.3% six months following surgery (p = 0.03). Additionally, the use of carbamazepine, gabapentin, pregabalin, duloxetine, and amitriptyline decreased. One year after surgery, 11/26 patients (42.3%) reported sustained pain relief. CONCLUSIONS: In this case series of NC-DREZ patients, we demonstrated that postoperative complications and subjective pain outcomes were comparable to those previously reported in the literature. Importantly, we demonstrated a reduction in the use of opioids six months after surgery. This study's findings support the use of NC-DREZ as an alternative treatment for painful trigeminal neuropathy. Large scale prospective studies are needed to confirm these results.