443 Bilateral Facial Pain With Simultaneous Onset in Trigeminal Neuralgia

Abstract

INTRODUCTION: Bilateral TN (BTN) represents a non-negligible disease burden. BTN is often sequential in nature, meaning pain develops on one side before developing on the contralateral side. The few cases of simultaneous onset BTN are often indiscriminately considered or not specified from sequential onset BTN cases. METHODS: A retrospective analysis was conducted to identify patients with simultaneous onset of bilateral TN. Demographic characteristics and comorbidities were assessed. Treatment plans and modalities were recorded, and procedural outcomes and treatment durability was assessed by determining median time pain recurrence in patients with at least 30 days of follow-up. Pharmacotherapy treatment and Barrow Neurological Institute pain intensity scores were compared at last follow-up with index treatment. RESULTS: Between 1996 and 2021, 17 out of 1723 patients with trigeminal neuralgia presented with simultaneous onset of bilateral trigeminal orofacial pain which underwent bilateral surgical intervention. Patients were followed for 3 to 148 months, during which 63 procedures were performed: 20 glycerin rhizotomies, 25 glycerin-radiofrequency rhizotomies, and 18 microvascular decompressions. 16 of 17 patients experienced pain recurrence after undergoing treatment: 12 with bilateral pain and 4 with unilateral recurrence. Glycerin-radiofrequency rhizotomy provided the greatest recurrence free interval (median = 15.4 months) compared to glycerin rhizotomy (median = 0.9 months; p = 0.02) and microvascular decompression (median = 7.8 months; p = 0.25). Over the course of treatment, the number of pharmacotherapy agents increased from 2 to 3 (p = 0.05). Overall facial pain scores improved from a median of 6 to 4 bilaterally. CONCLUSIONS: Patients with simultaneous bilateral trigeminal neuralgia represent a rare disease population who tend to have early pain recurrence after surgical treatment. Nevertheless, many experience overall pain improvement with re-treatment.