Management of trigeminal neuralgia by radiofrequency thermocoagulation

Abstract

IntroductionThe trigeminal neuralgia (TN) which is resistant to medical treatment has been benefited from many surgical techniques. Opinions differ regarding the best surgical treatment. ObjectiveThis study was done to evaluate the functional results of percutaneous radiofrequency thermocoagulation of trigeminal nerve in a consecutive series of 312 patients suffering from TN and to compare these results with the results of the other authors reported in the literature. MethodsThis retrospective study included 312 patients (280 with idiopathic TN, 8 with secondary or symptomatic TN, 20 with atypical TN, and 4 with post herpetic neuralgia) who underwent radiofrequency thermocoagulation of trigeminal nerve. This study was done in Alexandria main university hospital over a period of 7years starting from January 2003 to December 2009. The male to female ratio was 2 to 3 (124 males and 188 females) and their ages ranged from 27 to 100years with mean age of 48years. All patients had preoperative MRI brain examination. All cases underwent surgery in the form of radiofrequency thermocoagulation (RFT) of the affected division or divisions of trigeminal nerve under intravenous short acting anesthesia using C-arm radiological guidance. The straight temperature monitoring electrode was used to perform an initial lesion at 60–70°C for 120s and the patient awakened for sensory testing, the lesion may be repeated at the same temperature and duration if sensory deficit was not evident. Also forty two patients with recurrence (30 with idiopathic TN, 3 with secondary TN, and 8 with atypical TN, 1 with post herpetic neuralgia) had received another radiofrequency thermocoagulation lesion. Mean postoperative follow up examination period was 36months. ResultsThere was no operative mortality. Postoperatively, all the patients had immediate pain relief but only 86.5% of cases (270 patients) had continuous pain relief (250 with idiopathic TN, 5 with secondary or symptomatic TN, 12 with atypical TN, 3 with post herpetic neuralgia). After a mean postoperative follow up examination period of 1year pain recurred in forty two patients (13.5%) (30 with idiopathic TN, 3 with secondary TN, and 8 with atypical TN, 1 with post herpetic neuralgia). The operation was repeated in all cases with recurrence but only 30 cases were improved and the rest were shifted to other treatment modalities. Excellent results were obtained in 64% of patients, good results in 25.5% of patients, fair results in 6.5% of patients, and poor results in 4% of patients. ConclusionTN was predominant in females and the majority of patients had right V3 distribution. The outcome depends on the type of TN with best results with classical idiopathic type. Also better results occurred with isolated V3 affection. The radiofrequency thermocoagulation of trigeminal nerve is a low risk, highly effective and minimally invasive procedure that should be started with in all cases of TN.