Percutaneous Radiofrequency Rhizotomy Research Articles

A novel indicator to predict the outcome of percutaneous stereotactic radiofrequency rhizotomy for trigeminal neuralgia patients: diffusivity metrics of MR-DTI

A novel indicator to predict the outcome of percutaneous stereotactic radiofrequency rhizotomy for trigeminal neuralgia patients: diffusivity metrics of MR-DTI

Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study.

Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse. This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN. To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively. MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group. Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.

Angle and Distance Analysis on Percutaneous Trigeminal Radiofrequency Rhizotomy for Trigeminal Neuralgia

Angle and Distance Analysis on Percutaneous Trigeminal Radiofrequency Rhizotomy for Trigeminal Neuralgia

Effect of lesion temperature on the durability of percutaneous radiofrequency rhizotomies to treat trigeminal neuralgia.

Percutaneous radiofrequency rhizotomy is a common procedure for trigeminal neuralgia (TN) that creates thermocoagulative lesions in the trigeminal ganglion. Lesioning parameters for the procedure are left to the individual surgeon's discretion, and published guidance is primarily anecdotal. The purpose of this work was to assess the role of lesioning temperature on long-term surgical outcomes. This was a retrospective analysis of patients who underwent percutaneous radiofrequency rhizotomy from 2009 to 2020. Patient data, including demographics, disease presentation, surgical treatment, and outcomes, were collected from medical records. The primary endpoint was the recurrence of TN pain. Univariate and multivariate Cox proportional hazards regressions were used to assess the impact of chosen covariates on pain-free survival. A total of 280 patients who had undergone 464 procedures were included in the analysis. Overall, roughly 80% of patients who underwent rhizotomy would have a recurrence within 10 years. Lower lesion temperature was predictive of longer periods without pain recurrence (HR 1.05, p < 0.001). The inclusion of lesion time, postoperative numbness, prior history of radiofrequency rhizotomy, surgeon, and multiple sclerosis as confounding variables did not affect the hazard ratio or the statistical significance of this finding. Postoperative numbness and the absence of multiple sclerosis were significant protective factors in the model. The study findings suggest that lower lesion temperatures and, separately, postoperative numbness result in improved long-term outcomes for patients with TN who undergo percutaneous radiofrequency rhizotomies. Given the limitations of retrospective analysis, the authors suggest that a prospective multisite clinical trial testing lesion temperatures would provide definitive guidance on this issue with specific recommendations about the number needed to treat and trial design.

Analyzing the cost-effectiveness of microvascular decompression and percutaneous radiofrequency rhizotomy for trigeminal neuralgia: the role of clinical classification.

Trigeminal neuralgia (TN) is a neuropathic pain that can be treated with microvascular decompression (MVD) or percutaneous radiofrequency rhizotomy (PRR) when medications fail. However, the cost-effectiveness of these interventions is uncertain, and it is unclear whether TN should be considered as a single entity for cost-effectiveness analysis. To address these issues, a prospective cohort study was conducted between 2017 and 2020, documenting Burchiel et al.'s clinical classification, pain-free survival, complications, and costs. Two models of quality-adjusted life years (QALYs) were calculated: pain-specific (PQALY) and pain-complication-specific (PCQALY), based on pain-free survival and complications data, followed by cost-effectiveness analysis. The study included 112 patients, of whom 70 underwent MVD and 42 underwent PRR. Our findings revealed that MVD was less cost-effective in the PCQALY model than PRR, but more cost-effective in the PQALY model and had an incremental cost-effectiveness ratio (ICER) that met the World Health Organization cost-effectiveness threshold in both models. Further clinical classification analysis showed that MVD was only cost-effective in type 1 TN patients, with an ICER of 0.9 and 1.3 times the GDP/capita, based on PQALY and PCQALY, respectively, meeting the cost-effectiveness criteria. Conversely, MVD was economically dominated by PRR for type 2 TN patients based on PQALY. These findings indicate that PRR may be more cost-effective for type 2 TN patients, while MVD remains the cost-effective option for type 1 TN patients. Our study highlights the importance of clinical classification and complication in determining the cost-effectiveness of MVD and PRR for refractory TN.

Diagnosis and treatment of trigeminal neuralgia

Background: Trigeminal neuralgia is a sudden and painful facial condition that is triggered by activities of daily living. The pain is debilitating and patients are often unable to perform routine daily tasks such as washing their face, shaving, and brushing their teeth, which in turn has an impact on their social life and mental well-being as they are often anxious and fearful of not knowing when the pain may occur.Current Concepts: Treatment for trigeminal neuralgia involves local nerve destruction surgeries, including neuroblocking, percutaneous ethanol injection therapy, percutaneous radio-frequency rhizotomy, and gamma knife surgery. Although these types of surgeries reduce pain, the side effects are unpleasant and include decreased facial sensation, which originates from the damage to the trigeminal nerve. Furthermore, these surgeries provide insufficient long-term outcomes and symptoms often recur. Microvascular decompression is a radical surgical approach that separates the blood vessels that cause pain from the nerves. In a large-scale study, microvascular decompression significantly reduced the pain in 80–96% of the patients who underwent initial treatment. Of these, 85% experienced significant pain reduction 38 months post-surgery, and 72–85% reported that they were able to manage their pain 5 years post-surgery. Currently, microvascular decompression is the most appropriate surgical approach to control pain in patients with trigeminal neuralgia, as it exhibits the highest rate of pain control and lowest rate of recurrence.Discussion and Conclusion: The accurate diagnosis of trigeminal neuralgia, through clinical symptoms and imaging, is important to obtain good treatment outcomes. Microvascular decompression should be considered when a patient responds poorly to initial treatment approaches, cannot receive surgical treatment due to side effects, or experiences pain recurrence following local nerve destruction.

Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia using a Stereotactic Approach due to a Pterygoalar Bar

AbstractThe treatment of trigeminal neuralgia (TN) consists of pharmacotherapy and neurosurgical procedure, such as percutaneous radiofrequency rhizotomy. Here, we present the case of a patient with TN refractory to clinical treatment who presented an anatomical variation in the oval foramen, which required stereotactic-guided surgery to access the Gasser ganglion.This is a 63-year-old male patient who presented with TN refractory to drug treatment. He used carbamazepine and nortriptyline, with no satisfactory response. The percutaneous approach to radiofrequency thermocoagulation was indicated, in view of the comorbidities presented and the patient's age. Due to the presence of a rare anatomical variation, stereotactic-guided surgery was used to cannulate the foramen ovale and, thus, successfully perform the neurosurgical procedure with an excellent clinical response. The use of stereotaxy to guide cannulation of the foramen ovale due to anatomical variation was essential for the success of the procedure. The knowledge of the existence of this anatomical variation, and the mastery of the stereotactic technique enabled the adequate management in the face of the unusual situation.

Identifying a Novel Critical Access Difficulty Factor in Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia: Pterygoid Process Ridge.

Percutaneous stereotactic radiofrequency rhizotomy (PSR) is an ablative procedure for trigeminal neuralgia (TN). The anatomic structures that pass through, or around, the foramen ovale (FO) play vital roles in the success rate of PSR. The presence of a variant pterygoid process ridge (PPR) obscuring the FO renders the cannulation procedure difficult but had not been described in the literature before. To identify the variations of the PPR to assess cannulation difficulty. Fifty seven FOs of 57 patients with TN (TN group) and 438 FOs of 232 patients without TN (non-TN group) were analyzed using 3-dimensional computed tomography reconstruction images of cranial bases. Three-dimensional printer models were also used for TN patients with PPR-obscured FOs. Measurements were obtained for shape, size, and morphometric variability effect on cannulation. We identified 5 PPR-obscured FOs (8.8%) in the TN group and 32 FOs (7.3%) in the non-TN group. In the TN group, the transverse diameter obstruction ranged from 19.2% to 39.7% in 4 patients, and 1 case was 100%. Of particular note, approximately one-quarter to one-third of FO preset targets were affected by PPR. A PPR-obscured FO represents a new confounding factor in the conduct of PSR. Confirming the PPR-obscured FO is a critical step in improving the effectiveness of puncture target presetting, ie, evaluating the target with actual FO data is an improvement over the use of surgical view FO data. Discernment of the PPR can improve the success rate of difficult-to-access FO punctures, thereby rendering PSR more effective.

Percutaneous Radiofrequency Rhizotomy Is Equally Effective for Trigeminal Neuralgia Patients with or Without Neurovascular Compression.

Neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) can be a factor of treatment outcome, especially in microvascular decompression and stereotactic radiosurgery. No such effect has been reported in percutaneous radiofrequency rhizotomy (RF). This study aims to investigate whether NVC affects the efficacy of RF in patients with TN. We retrospectively reviewed patients with TN who received RF in our institution. Pretreatment magnetic resonance imaging was performed in every patient, and the presence of NVC was reviewed independently by two physicians. The patients were followed up at least for a year after the treatment. Pain severity was assessed with a numeric rating scale (NRS). Sixty-two patients were included in the study. All of the patients had single-sided lesions, and 35 patients had NVC. There were no significant differences between these two groups of patients in terms of gender distribution, age, and pretreatment pain severity. Comparable pain severity improvement was found at 1-year follow-up between these two groups (NRS 7.93 ± 0.492 without compression vs 7.57 ± 0.451 with compression, P = 0.600). No significant difference in posttreatment pain severity at 1 year was found between these two patient groups (NRS 1.37 ± 0.466 without compression vs 1.66 ± 0.458 with compression, P = 0.667). For patients with TN treated by RF, the presence or absence of NVC is not likely to affect the 1-year pain control rate.

Results of percutaneous rhizotomy for trigeminal neuralgia in patients with multiple sclerosis

Introduction. Neuropathic pain in trigeminal neuralgia (TN) is one of the most common and debilitating symptoms in patients with multiple sclerosis (MS). This condition in MS is due to the demyelination of pontine afferent fibers in the sensory root of the trigeminal nerve. The area of demyelination is usually located in the ventrolateral pons between the exit of the trigeminal nerve root and the trigeminal nucleus, which is confirmed on MRI. In some cases, neurovascular compression also plays a role in afferent fiber injury, leading to the so-called double crush effect. Conservative therapy for TN in patients with MS is often insufficiently effective, thus increasing the pertinence of surgical treatment. Materials and methods. The article reviews current pharmacological and surgical approaches to treating TN, findings from the literature, and our data on the safety and efficacy of percutaneous radiofrequency rhizotomy (PRR) for TN, based on the surgical treatment of 52 patients with MS at the Research Center of Neurology. Results. PRR works by interrupting the connection between peripheral receptor zones and the hyperactive trigeminal structures in the brainstem. All patients were discharged from the hospital on day 2–3 after surgery, with complete pain resolution. There were early and late relapses in some instances, which required a repeated PRR. Conclusion. PRR is a symptomatic surgical method that is safe, repeatable, and effective for treating TN in patients with MS, in whom pharmacological therapy has been ineffective or who could not tolerate it. For citation: Tyurnikov V.M., Askarova L.Sh., Trifonova O.V., Zakharova M.N., Gushcha A.O. [Results of percutaneous rhizotomy for trigeminal neuralgia in patients with multiple sclerosis]. Annals of clinical and experimental neurology. 2021; 15(1): 89–94. (In Russ.). https://doi.org/10.25692/ACEN.2021.1.11

Clinical efficacy of MVD combined with PSR in the treatment of primary trigeminal neuralgia.

Clinical efficacy of microvascular decompression (MVD) combined with percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of primary trigeminal neuralgia was investigated. The medical records of 141 patients with primary trigeminal neuralgia admitted to Shandong Provincial Hospital from May 2011 to June 2013 were collected. Among them, 63 patients received MVD surgery and were set as group A, while the other 78 received MVD combined with PSR and were as group B. The efficacy and complication of the two treatment methods were compared. Multivariate logistic regression was performed to analyze the risk factors for treatment efficacy. The total effective rate was 96.15% in group B, higher than that in group A (88.89%), but the difference was not statistically significant (P>0.05). The complications in group B were statistically less than that in group A (P<0.05). Risk factors for the onset of primary trigeminal neuralgia included the degree of decompression, duration of disease, degree of compression, and clinical symptoms. Patients treated with MVD combined with PSR had a better quality of life and lower 5-year recurrence rate than patients treated with MVD (both P<0.05). In conclusion, MVD combined with PSR treatment has good clinical efficacy in primary trigeminal neuralgia and low incidence of complications. The possible risk factors for the onset of primary trigeminal neuralgia include the degree of decompression, duration of disease, degree of compression, and clinical symptoms.

A Retrospective Review of the Outcomes and Utility of Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia Using Anatomic Landmark Guidance in Asleep Patients

Radiofrequency rhizotomy is a percutaneous procedure for trigeminal neuralgia frequently performed with intermittent awakening, although the utility and accuracy of this procedure in continuously sedated patients have not yet been evaluated. To evaluate pain relief in patients with trigeminal neuralgia undergoing radiofrequency rhizotomy under continuous sedation. Patients from 2012 to 2017 who underwent radiofrequency rhizotomy for trigeminal neuralgia were evaluated retrospectively. Barrow Neurological Institute Pain Intensity scores were assigned to determine relapse at 1 mo, 1 yr, 3 yr, and 5 yr. Descriptive relapse rates for patients with multiple sclerosis and those undergoing repeat procedures are also reported. A total of 90.8% of procedures reported Barrow Neurological Institute I-III score at 1 mo (P<.0001), 66.3% at 1 yr (P=.0012), and 71.1% at 3 yr (P=.0003). Duration to relapse was 3.0 and 6.0 at 1 and 3 yr, respectively. Procedures in patients with multiple sclerosis reported 100% relief at 1 mo and 87.5% relief at 1 yr (P=.0099). The presence of numbness and postoperative medication changes were not associated with pain relief (P=.0063, P=.1338). The use of continuous sedation in radiofrequency rhizotomy for trigeminal neuralgia provides pain relief comparable to the recorded literature rate for procedures with intermittent awakening.

Clinical Outcome of Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia at a Tertiary Care Hospital.

Background: - Trigeminal neuralgia is a disease typically characterized by involuntary attacks of lancinating pain in the distribution of the trigeminal nerve that are activated by non-noxious stimuli. Numerous anticonvulsants, either alone or in combination, remain the first choice in the medical treatment of trigeminal neuralgia.3If the disease becomes non responsive, there are numerous surgical options like micro vascular decompression or minimally invasive percutaneous lesioning of the trigeminal nerve, such as glycerol rhizolysis, Radiofrequency Rhizotomy, and balloon compression. Objective: - To determine efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of early pain relief in a tertiary care hospital. Methods: - 62 patients with refractory trigeminal neuralgia or lancinating, recurrent episodes of pain in the distribution of Ophthalmic (V1) and Mandibular (V3) branches of trigeminal nerve, not responsive to 6 months of conservative treatment were included. Study was completed in one year i.e. from March 2015 to Feb 2016. Result: - In our study population, 62 included patients were had mean age 56.08 ± 7.39 years. 44 patients (71%) were male. Our treatment was effective in 58 patients (93.5%) while there was recurrence among 4 (6.5%) only. Conclusion: - It is concluded that the efficacy of percutaneous Radiofrequency Rhizotomy for trigeminal neuralgia in terms of complete relief of pain with intact sensations in treated branch region is excellent (93.5%).

Comprehensive anatomy of the foramen ovale critical to percutaneous stereotactic radiofrequency rhizotomy: cadaveric study of dry skulls.

Percutaneous stereotactic radiofrequency rhizotomy (PSR) is often used to treat trigeminal neuralgia, a serious condition that results in lancinating, episodic facial pain. Thorough understanding of the microsurgical anatomy of the foramen ovale (FO) and its surrounding structures is required for efficient, effective, and safe use of this technique. This morphometric study compares anatomical and surgical orientations to identify the variations of the FO and assess cannulation difficulty. Bilateral foramina from 174 adult human dry skulls (348 foramina) were analyzed using anatomical and surgical orientations in photographs from standardized projections. Measurements were obtained for shape, size, adjacent structures, and morphometric variability effect on cannulation. The risk of potential injury to surrounding structures was also assessed. The authors identified 6 distinctive shapes of the FO and 5 anomalous variants from the anatomical view, and 6 shapes from the surgical view. In measurements of surface area of this foramen obtained using the surgical view, loss (average 18.5% ± 5.7%) was significant compared with the anatomical view. Morphometrically, foramen size varied significantly and obstruction from a calcified pterygoalar ligament occurred in 7.8% of specimens. Importantly, 8% of foramina were difficult to cannulate, thus posing a 12% risk of inadvertent cannulation of the foramen lacerum. Significant variability in the FO's shape and size probably affected its safe and effective cannulation. Preoperative imaging by 3D head CT may be helpful in predicting ease of cannulation and in guiding treatment decisions, such as a percutaneous approach over microvascular decompression or radiosurgery.

Anatomical rationale for surgical treatment of trigeminal neuralgia combined with cerebellopontine angle tumors

We performed a retrospective analysis of 51 patients (38 females and 13 males aged 22 to 77 years) with TN and ipsilateral CPA tumors. Space-occupying lesions were represented by 29 meningiomas of the petrous apex, 11 epidermoids, 9 vestibular schwannomas, 1 hemangioma, and 1 cavernoma. Intraoperatively, we identified 6 types of the anatomical relationships among the TNR, tumors, and CPA vessels: type I - the TNR is completely surrounded by the tumor (4 epidermoids); type II - the tumor compresses and displaces the TNR (21 meningiomas, 4 schwannomas, and 6 epidermoids); type III - the tumor occurs inside the TNR (1 cavernoma); type IV - the tumor together with the vessel compresses the TNR (3 meningiomas and 1 epidermoid); type V - the tumor displaces the TNR towards the vessel (5 meningiomas and 5 schwannomas); type VI - the tumor does not contact the TNR that is compressed by the vessel (1 hemangioma). Preoperative MRI and intraoperative findings revealed compression and deformity of the brain stem at the TNR entry level in all but two patients. Vascular compression of the TNR (usually by the superior cerebellar artery) was found in 15 of 51 patients. Microvascular decompression (MVD) was performed using various techniques: interposition of implants between vessels and the TNR, transposition of the compressing vessels from the TNR, or transposition of the nerve root. In all patients, except 1, pain syndrome regressed immediately after tumor removal and MVD. In 1 case, the pain syndrome did not regress after total removal of epidermoid and MVD, and TN was resolved by percutaneous radiofrequency rhizotomy. Long-term postoperative follow-up results showed complete elimination of TN in all cases; there were no persistent neurological complications and postoperative mortality. TN may result from direct compression and deformation of the TNR and brain stem by CPA tumors. In some cases, the cause of TN is combined compression of the TNR by the tumor and vessels. Assessment of the neurovascular relationships requires detailed examination of the entire TNR after tumor removal. In the case of vascular compression of the TNR, various MVD techniques can be used for treatment of TN.

Modular organization of brain resting state networks in patients with classical trigeminal neuralgia.

The modular organization of brain networks in trigeminal neuralgia patients has remained largely unknown. We aimed to analyze the brain modules and intermodule connectivity in patients with trigeminal neuralgia before and after percutaneous radiofrequency rhizotomy treatment to identify specific modules that may be associated with the development and brain plasticity of trigeminal neuralgia and to test the ability of modularity analysis to be a predictive imaging biomarker for the treatment effect in patients with trigeminal neuralgia. A total of 25 patients with right trigeminal neuralgia and 20 matched healthy subjects were included. Blood-oxygen-level dependent resting state fMRI was used to analyze the brain modular organization. Whole brain modularity analysis identified seven modules. The metric of intermodule connectivity, participation coefficient, of the sensorimotor network and default mode network modules were significantly lower in patients and increased after surgery. The participation coefficient of the subcortical modules was associated with the pain duration. Higher communication between the default mode network module and other modules before surgery was associated with a better treatment response. Furthermore, the subcortical module was a significant contributor to the participation coefficient relationship of the default mode network module with the treatment response, and the bilateral midcingulate cortex and thalamus were major connectors in the subcortical module. These findings have important implications regarding the global brain modular responses to chronic neuropathic pain and it may be feasible to use the modularity analysis as part of a risk stratification to predict the treatment response.

Radiofrequency Management of Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is a unique disease. The first line of management in TN is medical treatment using antiepileptic drugs, when drugs failed to control the pain or when there is intolerability to them, surgical interventions are then indicated. Percutaneous Trigeminal rhizotomy (PTR) is recommended for elderly patients with higher operative risk factors. Objective: The aim of this work is to review the literature regarding the pathology, methods of investigations, operative techniques, complications of management of trigeminal neuralgia and eventually prognosis, also evaluation of the effectiveness of the radiofrequency percutaneous radiofrequency rhizotomy - for management of trigeminal neuralgia. Patients and Methods: This study included a total of 15 patients with trigeminal neuralgia presented predominantly in females. Female: male 1.7:1 and the mean age was 53 years. They were admitted and managed at the Neurosurgical Department of at Al-Azhar University Hospitals and other private centers between June 2017 and October 2018. Clinical follow-up was obtained in 15 (100%) patients. Results: follow up revealed that 11 patient (73.4 %) had favorable outcome and 4 patient (26.6%) had unfavorable outcome. The mean preoperative visual analogue scale(VAS) was 7.83 (range 7-10). It dropped immediately postoperative to 2.33 (range 1- 4).), intraoperative complication was noted in 3 cases (18%).Conclusion: Radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments and patients at high risk from general anesthesia (although not necessarily the elderly).

Percutaneous radiofrequency rhizotomy for cervical zygapophyseal joint mediated neck pain: A retrospective review of outcomes in forty-four cases.

Percutaneous radiofrequency (RF) rhizotomy of the medial branches of the dorsal rami from the spinal nerves is the standard treatment for cervical zygapophyseal joint mediated pain. There is a paucity of data regarding the longevity of analgesia following this procedure. To determine the duration of complete pain relief, analgesic consumption and any adverse events following percutaneous cervical RF rhizotomy. Retrospective chart review of patients who had undergone percutaneous cervical RF rhizotomy for zygapophyseal joint mediated neck pain. Patient reviews were undertaken by the pain consultant at 6 weeks, 6 months and 1 year following the procedure. Where follow-up was incomplete, the patient was assumed only to have had pain relief until their last review where complete pain relief had been documented. Analgesic consumption and any adverse events were recorded. The data was analysed using Microsoft Excel®. At 12 months 63.64% of patients were pain free. Median duration of complete pain relief was 52 weeks. Patients who experienced pain relief had ceased using prescription analgesia by their 6 week review. There were no repeat cervical RF rhizotomies, procedure related infections or unplanned hospital admissions. Percutaneous cervical RF rhizotomy is an effective treatment for cervical zygapophyseal joint mediated neck pain.

The cost-effectiveness of surgery for trigeminal neuralgia in surgically naïve patients: A retrospective study

ObjectiveFor 75% of patients with trigeminal neuralgia (TN), the pain can be controlled with medication. For those who fail medication therapy, surgical options include microvascular decompression (MVD), percutaneous radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS). Few studies have explored the relative cost-effectiveness of these interventions, particularly in surgically naïve patients. MethodsA retrospective chart review performed between January 2003 and January 2013 identified a total of 89 patients who underwent surgical treatment for TN (MVD=27, RFR=23, SRS=39). Outcome measures included facial pain (excellent=no pain, no medications; good=no pain, medications required; fair=>50% decrease in pain; and poor=<50% decrease in pain/secondary surgery), numbness, cost, and the need for a subsequent procedure. ResultsThe average age of patients for each procedure was MVD=53.9±16, RFR=76.2±16, and SRS=74.5±12 (p<0.001 MVD vs. other modalities). Total charges for the procedures (US dollars) were MVD=50,100±9600, RFR=4700±2200, and SRS=39,300±6000 (p<0.001). Actual collections varied by insurance. Percentages of postoperative facial numbness were MVD=11%, RFR=52%, and SRS=28% (p<0.01). At two years, the rates of recurrence requiring a second procedure were MVD=22%, RFR=74%, and SRS=31% (p<0.01). Average times to secondary procedure in months were MVD=26±29, RFR=59±76, and SRS=35±25. Mean quality adjusted pain-free years were MVD=1.58, RFR=2.28, and SRS=0.99. Cost-effectiveness calculations in US dollars showed MVD=31,800, RFR=2100, and SRS=39,600 (p<0.001). ConclusionThere are significant cost differences among the three most common surgical procedures for TN. MVD was the most expensive procedure, was more likely to be performed on younger patients, had the lowest rate of facial numbness, and had the lowest rate of recurrence requiring a secondary procedure. SRS was slightly less costly, more likely to be performed on an older population, and had a rate of recurrence similar to MVD. RFR was the least expensive procedure, provided immediate relief, but was associated with the highest rates of facial numbness and recurrence. Based on cost-effectiveness, considering both cost and outcome, RFR was the most cost-effective, followed by MVD, and finally SRS.

167 The Cost Effectiveness of Surgery For Trigeminal Neuralgia in Surgically Naive Patients, A Retrospective Study

INTRODUCTION: For 75% of patients with trigeminal neuralgia (TN), the pain can be controlled with medications. For those who fail medication therapy, surgical options include microvascular decompression (MVD), percutaneous radiofrequency rhizotomy (PRFR), and stereotactic radiosurgery (SRS). Few studies have explored cost effectiveness, particularly in surgically naive patients. METHODS: A retrospective chart review performed between 01/2003 and 01/2013 identified a total of 81 patients who underwent surgical treatment for TN (MVD = 39; PRFR = 16; SRS = 26). Outcome measures included facial pain [excellent (no pain, no medications), good (no pain, medications required), fair (>50% decrease in pain), and poor (<50% decrease in pain/secondary surgery)], numbness, and cost. RESULTS: Average ages of patients were MVD = 53.7 ± 14 (14-83), PRFR = 75.4 ± 13 (38-92), and SRS = 73.4 ± 13 (41-86). Mean quality adjusted pain-free years were MVD = 1.58, PRFR = 2.28, and SRS = 0.99. Total fees for the procedures (US dollars) were MVD = 50 100 ± 9600, PRFR = 4800 ± 2200, and SRS = 39,300 ± 6000. Actual collections varied by insurance. Percent of postoperative facial numbness was MVD = 13%, PRFR = 75%, and SRS = 12%. Rates of recurrence requiring a second procedure were MVD = 10%, PRFR = 57%, and SRS = 16%. Cost Effectiveness calculations showed MVD = 32,000, PRFR = 2000, and SRS = 40,000. CONCLUSION: There are significant cost differences among the common surgical procedures for TN. MVD was the most expensive procedure, more likely to be performed on younger patients, and had the lowest rate of facial numbness as well as recurrence requiring a secondary procedure. SRS was slightly less costly, more likely to be performed on an older population, and had a similar rate of facial numbness and recurrence. PRFR was the least expensive procedure, provided immediate relief, but was associated with the highest rates of facial numbness and recurrence. Based on cost-effectiveness, considering both cost and outcome, PRFR was the most cost-effective followed by MVD and finally SRS.