Percutaneous glycerol rhizolysis of the trigeminal ganglion for the treatment of idiopathic and classic trigeminal neuralgia: Outcomes and complications

Bethamcharla, Raviteja; Abou‐Al‐Shaar, Hussam; Maarbjerg, Stine; Chang, Yue‐Fang; Gacka, Caroline N.; Sekula, Raymond F.

doi:10.1111/ene.15977

Cited by 2 publications

(1 citation statement)

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“…We recently published a cohort study, “Percutaneous glycerol rhizolysis of the trigeminal ganglion for the treatment of idiopathic and classic trigeminal neuralgia: outcomes and complications,” of 45 patients with idiopathic trigeminal neuralgia (iTN) with absent arterial contact or venous contact only and classic trigeminal neuralgia (TN) with morphological changes of the trigeminal nerve secondary to venous compression or distortion. 2a At our institution, microvascular decompression (MVD) is not routinely recommended for these patients, as the degree of neurovascular compression has been identified as an important prognostic indicator of pain-freedom for trigeminal neuralgia treated with MVD. 3a Our paper found that patients with iTN and classic TN with morphological changes secondary to venous compression treated with percutaneous glycerol rhizolysis have a high rate (87.9%) of short-term pain relief (1-2 years), but at last follow-up (median 3.07 years) a significant proportion of patients have pain relapse (72.7%).…”

Section: Commentsmentioning

confidence: 99%

Neurovascular Compression in Patients With Trigeminal Neuralgia May Be Associated With Worse Outcomes After Primary Percutaneous Rhizotomy

Nair,

Al-Khars,

Kalluri

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Percutaneous rhizotomy may be an effective primary intervention in patients with trigeminal neuralgia who are poor candidates for microvascular decompression or those who desire a less invasive approach. However, the influence of neurovascular compression on pain-free survival after primary percutaneous rhizotomy is not well understood. METHODS: We retrospectively reviewed all patients undergoing percutaneous rhizotomy at our institution from 1995 to 2022. Patients were included if they had no history of surgical intervention, available preoperative MRI imaging, and postoperative follow-up data. Barrow Neurological Institute pain scores were assigned at various time points. We collected baseline patient information, pain characteristics, and perioperative complications for each patient. In addition, we recorded evidence of pain recurrence. Patients were dichotomized into those with evidence of neurovascular compression on preoperative MRI vs those without. The effect of neurovascular compression on pain-free survival was assessed using Kaplan-Meier Cox proportional hazards analyses. RESULTS: Of the 2726 patients reviewed, 298 met our inclusion criteria. Our study comprised 261 patients with no evidence of neurovascular compression on preoperative MRI vs 37 patients with evidence of neurovascular compression on preoperative MRI. Patients in the compression group had a shorter median duration to recurrence compared with those in the no compression group, P = .01. Kaplan-Meier survival analysis revealed that patients with preoperative evidence of neurovascular compression on MRI imaging demonstrated shorter pain-free survival compared with those without such evidence [hazard ratio = 1.57 (1.03-2.4), P = .037]. Cox proportional hazards analysis demonstrated that evidence of neurovascular compression was associated with poor pain-free survival [hazard ratio = 1.64 (1.06-2.53), P = .03]. CONCLUSION: Patients with neurovascular compression on preoperative MRI may experience reduced time to recurrence compared with those without after percutaneous rhizotomy. These patients should be counseled on potential reduced efficacy of percutaneous rhizotomy as a primary intervention for their pain.

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Section: Commentsmentioning

confidence: 99%