Effect of Training on Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia: A Long-Term, Retrospective Comparison of Staff Neurosurgeon and Trainee Complications and Efficacy

Abstract

The role of trainee involvement in lesioning procedures for trigeminal neuralgia (TN) has not yet been investigated in reported studies. The objective of the present study was to compare the complications and efficacy of percutaneous glycerol rhizotomy (GR) when performed by staff neurosurgeons and trainees. A retrospective medical record analysis of 165 patients with medically refractory TN who had undergone 293 GR procedures by either a staff attending (n= 156) or trainee (n= 137) from 2007 to 2018 was performed. The data were analyzed with respect to procedure time, fluoroscopy time and radiation exposure, complication rates and outcomes. No difference was found in procedure duration between the teaching and nonteaching cases and only a nonsignificant trend was found toward a longer fluoroscopy time for the latter. The initial response rates to GR were equal for staff attending (88.7%) and trainee (87.2%) cases (P= 0.708). Similarly, no statistically significant difference (P= 0.48) was found between the median time to recurrence for the staff attending cases (1.6 ± 0.3 years) compared with that of the trainee cases (1.7 ± 0.3 years). The overall incidence of complications was low (7.5%). The occurrence of facial hypoesthesia correlated with the amount of glycerol injected (P < 0.01). GR for the treatment of TN can safely be performed by senior residents and fellows under supervision.