Comparative Study Regarding Efficacy of Radiofrequency Rhizotomy and the Microvascular Decompression in the Treatment of Trigeminal Neuralgia

  • ABDUL MAJID Department of Neurosurgery, PGMI/Lahore General Hospital, Lahore
  • MUHAMMAD FAROOQ Department of Neurosurgery, PGMI/Lahore General Hospital, Lahore
  • MUHAMMAD SHAKIR Department of Neurosurgery, PGMI/Lahore General Hospital, Lahore
  • ZUBAIR MUSTAFA KHAN Department of Neurosurgery, PGMI/Lahore General Hospital, Lahore
  • SAJID IQBAL Department of Neurosurgery, PGMI/Lahore General Hospital, Lahore
Keywords: Microvascular decompression, Radiofrequency Rhizotomy, Trigeminal Neuralgia

Abstract

Objective: Trigeminal neuralgia is the lancinating electric shock like pain because of neurovascular compression in trigeminal nerve distribution. We compared the efficacy of radiofrequency rhizotomy with microvascular decompression in terms of complete pain relief.
Material and Methods: The randomized controlled trial study was conducted in the neurosurgery department, LGH Lahore for a period of one year June 2017 to June 2018. A total of 110 patients were included and distributed into two groups, i.e. group-I who underwent radiofrequency rhizotomy (RFR) and group-II who underwent microvascular decompression (MVD). Follow-up of all the patients was assured up to six months. All the data were analyzed using S.P.S.S Ver. 23.0.
Results: There were 38 (34.6%) male and 72(65.4%) female. Mean age was 51.25 ± 8.80 years. At the end of six months, in Group-I (RFR), Nineteen (34.5%) patients were completely pain free, 25 (45.5%) patients had significant pain relief, 7 (12.7%) had mild improvement in the pain and 4 (7.3%) patients had no improvement in the pain. In group-II (MVD), 30 (54.5%) patients were completely pain free, 14 (25.5%) had significant pain relief, 9 (16.4%) had mild improvement and 2 (3.6%) had no improvement in their pain (Chi-square = 6.49, p = 0.090).
Conclusion: Microvascular decompression had better results than a radiofrequency rhizotomy in patients presenting with trigeminal neuralgia regarding excellent pain relief and fewer complications.

References

1. Li Y, Mao F, Cheng F, Peng C, Guo D, Wang B. A meta-analysis of endoscopic microvascular decompression versus microscopic microvascular decompression for the treatment for cranial nerve syndrome caused by vascular compression. World neurosurgery, 2019.
2. Straus DC, Ko AL, Sekhar LN. Trigeminal Neuralgia. Principles of Neurological Surgery: Elsevier, 2018; 745-52.
3. Gornitsky M, Elsaraj SM, Canie O, Mohit S, Velly AM, Schipper HM. Greater palatine block for V2 trigeminal neuralgia: Case report. Special Care in Dentistry, 2019; 39 (2): 208-13.
4. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. European journal of neurology, 2019; 26 (6): 831-49.
5. Jafree DJ, Zakrzewska JM. Long-term pain relief at five years after medical, repeat surgical procedures or no management for recurrence of trigeminal neuralgia after microvascular decompression: analysis of a historical cohort. British journal of neurosurgery, 2019; 33 (1): 31-6.
6. Ravina K, Strickland BA, Rennert RC, Bakhsheshian J, Russin JJ, Giannotta SL. Revision Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm: Factors Associated with Surgical Failure. Journal of Neurological Surgery Part B: Skull Base, 2019; 80 (01): 031-9.
7. Tanaka T, Shiiba S, Yoshino N, Harano N, Sago T, Kito S, et al. Predicting the therapeutic effect of carbamazepine in trigeminal neuralgia by analysis of neurovascular compression utilizing magnetic resonance cisternography. International journal of oral and maxillofacial surgery, 2019; 48 (4): 480-7.
8. Shah RJ, Padalia D. Sphenopalatine Ganglion Radiofrequency Thermocoagulation. Stat Pearls. Treasure Island (FL), 2019.
9. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014; 348: g474.
10. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Therapeutics and clinical risk management, 2015; 11: 289.
11. Wang DD, Raygor KP, Cage TA, Ward MM, Westcott S, Barbaro NM, et al. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. Journal of neurosurgery, 2018; 128 (1): 68-77.
12. Jafree DJ, Williams AC, Zakrzewska JM. Impact of pain and postoperative complications on patient-reported outcome measures 5 years after microvascular decompression or partial sensory rhizotomy for trigeminal neuralgia. Acta neurochirurgica, 2018; 160 (1): 125-34.
13. Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology, 2016; 87 (2): 220-8.
14. Asplund P, Blomstedt P, Bergenheim AT. Percutaneous balloon compression vs percutaneous retrogasserian glycerol rhizotomy for the primary treatment of trigeminal neuralgia. Neurosurgery, 2015; 78 (3): 421-8.
15. Staudt MD, Rivera M, Miller JP. Percutaneous procedures for trigeminal neuralgia. Diagnosis and Management of Head and Face Pain: Springer, 2018: p. 221-33.
16. Nanjappa M, Kumaraswamy S, Keerthi R, Ashwin D, Gopinath A, Reyazulla M, et al. Percutaneous radiofrequency rhizotomy in treatment of trigeminal neuralgia: a prospective study. Journal of maxillofacial and oral surgery, 2013; 12 (1): 35-41.
17. Huang C, Wan Z, Wan C, Li Y, Zhong R. Clinical factors and safety of microvascular decompression in the treatment of trigeminal neuralgia. Biomedical Research, 2018; 29 (9): 1845-51.
18. Khan SA, Khan B, Khan AA, Afridi EAK, Mehmood S, Muhammad G, et al. Microvascular decompression for trigeminal neuralgia. Journal of Ayub Medical College Abbottabad, 2015; 27 (3): 539-42.
19. Xie E, Garzon-Muvdi T, Bender M, Doshi T, Carson B, Lim M, et al. Association Between Radiofrequency Rhizotomy Parameters and Duration of Pain Relief in Trigeminal Neuralgia Patients with Recurrent Pain. World neurosurgery, 2019.
Published
2019-09-27
Section
Original Article