Effect of Various Surgical Modalities in Recurrent or Persistent Trigeminal Neuralgia

Han, Inbo; Shin, Dong Ah; Chang, Jong Hee; Kim, Keungnyn; Chang, Jinwoo; Huh, Ryoong; Chung, Seungsoo

doi:10.1159/000303530

Cited by 23 publications

(13 citation statements)

References 41 publications

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“…Han et al [13] reported that MVD may be used as an effective alternative for patients with a history of failed percutaneous procedures. We also believe that other surgical procedures may be used as an effective alternative for patients resistant to PRT.…”

Section: Discussionmentioning

confidence: 99%

Repeated CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia

Tang

Jin²,

Li³

et al. 2014

Eur Neurol

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Aims: To investigate the long-term outcomes of repeated percutaneous radiofrequency thermocoagulation (PRT) for recurrent trigeminal neuralgia (TN) patients. Methods: Between 2002 and 2012, 33 patients with recurrent TN following an initial PRT procedure were retrospectively studied and underwent 43 repeated PRT procedures. Results: The mean length of follow-up after repeated PRT was 34 months. Pain relief was immediate in 30 patients (90.9%), and no pain relief occurred in 3 patients (9.1%) following a second PRT procedure. The percentage of patients who remained in an ‘excellent' and ‘good' pain relief condition (pain intensity ≤BIN grade III) after the second PRT procedure was 75% at 1 year, 68% at 2 years and 68% at 5 years, and 22 of these patients (54.5%) remained satisfied with their pain relief during the follow-up period. Nine patients underwent PRT three times and 1 patient four times. The total number of patients who benefited from repeated PRT was 28 (84.8%). Postprocedure complications including masseter weakness were present in 3 patients and limited mouth opening affected 1 patient. No mortalities were observed during or after repeated PRT procedures. Conclusion: Repeated PRT provides long-term pain relief benefits to patients with recurrent TN and should be considered as an alternative treatment for recurrent TN.

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Section: Discussionmentioning

confidence: 99%

Repeated CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia

Tang

Jin²,

Li³

et al. 2014

Eur Neurol

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“…It is a common disorder having great impact on the quality of life of patients (Yoshino et al, 2003;Han et al, 2010). Besides medication and interventional procedures, radiofrequency thermocoagulation (RFT) is one of the most important surgical approaches extensively applied in the treatment of TN.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency thermocoagulation combined with pulsed radiofrequency helps relieve postoperative complications of trigeminal neuralgia

Zhao¹,

Wang²,

Mw³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. Trigeminal neuralgia is a sudden, severe condition characterized by stabbing and recurrent pain. Radiofrequency thermocoagulation (RFT) and pulsed radiofrequency (PRF) are common surgical interventions used to treat trigeminal neuralgia. This study aimed to investigate the therapeutic effects and associated complications of a combination of RFT and PRF in the treatment of trigeminal neuralgia. Computed tomography-guided percutaneous RFT of the Gasserian ganglion was performed on 80 patients with trigeminal neuralgia. Patients were randomly assigned to either group A (RFT at 70°C) or group B (RFT at 75°C). Patients in each group were divided into 2 subgroups, receiving percutaneous RFT (240 s) with or without PRF (42°C, 2 Hz, 240 s). Six months later, pain relief and complication status were evaluated. There was no significant difference in visual analogue scores among groups with RFT at 70° or 75°C, with or without PRF. Data showed that facial numbness and postoperative masticatory muscle weakness recovered more rapidly in patients receiving combined RFT and PRF treatment. Decreased corneal reflex was relieved to a significantly greater extent in groups receiving PRF than those without. Thus, compared to the use of RFT at 75°C alone, the combination of PRF and RFT helped eliminate postoperative complications, such as facial numbness, masticatory muscle weakness, and decreased corneal reflex, indicating that it could be useful for surgically treating trigeminal neuralgia.

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“…In these instances, recurrence can be prevented. Although the success rate of re-operation was lower than that of the initial operation, performing a second surgery showed a higher long-term success rate than did other treatment modalities1630). There was a higher risk of facial dysesthesia after a second surgery than after the first surgery.…”

Section: Discussionmentioning

confidence: 86%

A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

Kang

Park

et al. 2016

J Korean Neurosurg Soc

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ObjectiveAlthough many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments.MethodsWe performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16–173). The mean interval between the prior treatment and second surgery was 26 months (range : 7–123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale.ResultsAmong the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery.ConclusionSurgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.

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Effect of Various Surgical Modalities in Recurrent or Persistent Trigeminal Neuralgia

Cited by 23 publications

References 41 publications

Repeated CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia

Repeated CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia

Radiofrequency thermocoagulation combined with pulsed radiofrequency helps relieve postoperative complications of trigeminal neuralgia

A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

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