A refined percutaneous rhizotomy with DSA-guided ethanol for the second-line treatment of trigeminal neuralgia

Abstract

BackgroundPercutaneous rhizotomy is a group of techniques used to treat trigeminal neuralgia. Radiofrequency thermocoagulation (RF) and Chemical Rhizotomy (CR) using glycerol are among the most frequently used methods. We have recently refined Ethanol Rhizotomy (ER) under Digital Subtraction Angiography (DSA) guidance. ObjectiveA descriptive, retrospective study was conducted to compare our refined ER and RF ablation in patients with trigeminal neuralgia in terms of long-term pain relief and side effects. MethodBetween 2012 and 2014, 33 patients with typical trigeminal neuralgia were enrolled, 10 of whom received RF and 23 received ER under (DSA) guidance with ethanol injected while in the supine position. The pain relief, duration of pain-free period, need for repeat injection, and recurrence of pain were recorded together with procedure-related complications within 7 years after the procedures. ResultsAfter a single intervention or, in some cases, a maximum of two repeated interventions, all 33 patients experienced complete pain relief. Nevertheless, following a single procedure, the success rate was 95.6% (22/23) in the ER group and 60% (6/10) in the RF group. Notably, complete numbness was the most significant side effect, with a higher incidence in the ER group (30.4%) compared to the RF group (0%) (p = 0.02). The recurrence rate was statistically different (p = 0.01) between the two groups, with 4.4% and 40% recorded in the ER and RF groups, respectively. ConclusionWe demonstrated the usefulness of our refined ER procedure as a safe, cost-effective, and efficient second-line treatment for TN.