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

  • Muhammad Hassan Raza Punjab Institute of Neurosciences (PINS), Lahore General Hospital, Lahore
  • Adeeb ul Hassan Punjab Institute of Neurosciences (PINS), Lahore General Hospital, Lahore
  • Omair Afzal Ali Punjab Institute of Neurosciences (PINS), Lahore General Hospital, Lahore
  • khalid Mahmood Punjab Institute of Neurosciences (PINS), Lahore General Hospital, Lahore

Abstract

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%).

References

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2. Koopman JS, Dieleman JP, Huygen FJ. Incidence of facial pain in the general
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6. Yang T, Lin M, Lee M, Weng H, Liao H. Percutaneous Trigeminal Nerve Radiofrequency Rhizotomy Guided by Computerized Tomography with Three-dimensional Image Reconstruction. Chang Gung Med J 2010;33:679-83
7. Cheng JS, Lim DA, Chang EF, Barbaro NM. A Review of Percutaneous Treatments for Trigeminal Neuralgia. Neurosurgery 2013;23:
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9. Wang DD, Ouyang D, Englot DJ, Rolston JD, Molinaro AM, Ward M, et al. Trends in surgical treatment for trigeminal neuralgia in the United States of America from 1988 to 2008. J Clin Neurosci 2013; available at http://dx.doi.org/10.1016/j.jocn.2012.12.026-32.
10. Harden RN. Chronic neuropathic pain. Mechanisms, diagnosis, and treatment. Neurologist 2005; 11:111-6.
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14. Elias J, Kuniyoshi R, Carloni WV. Glossopharyngeal neuralgia associated with cardiac syncope. Arq Bras Cardiol 2002; 78:510-15.
15. Soh KB. The glossopharyngeal nerve, glossopharyngeal neuralgia and the Eagle's syndrome--current concepts and management. Singapore Med J 1999; 40:659-65.
16. Laha RK, Jannetta PJ. Glossopharyngeal neuralgia. J Neurosurg 1977; 47:316-22.
17. Patel A, Kassam A, Horowitz M, Chang YF. Microvascular decompression in the management of glossopharyngeal neuralgia: analysis of 217 cases. Neurosurgery 2002; 50:705-9.
18. Bruyn GW. Superior laryngeal neuralgia. Cephalalgia 1983; 3:235-9.
19. Watson P, Evans R. Cluster-tic syndrome. Headache 1985; 25:123-8.
20. Mulleners WM, Verhagen WI. Cluster-tic syndrome. Neurology 1996; 47:302-6.
21. Jaeger B, Singer E, Kroening R. Reflex sympathetic dystrophy of the face. Report of two cases and a review of the literature. Arch Neurol 1986; 43:693-8.

REFERENCES:
1. Shakur SF, Bhansali A, Mian AY, Rosseau GL. Neurosurgical Treatment of Trigeminal Neuralgia. Dis Mon 2011;57:570-82
2. Koopman JS, Dieleman JP, Huygen FJ. Incidence of facial pain in the general
population. Pain 2009;147:122-7.
3. Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir 2008;150:243-55.
4. Toda K. Operative treatment of trigeminal neuralgia: review of current techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:788-805.
5. Meng FG, Wu CY, Liu YG, Liu L. Virtual reality imaging technique in percutaneous radiofrequency rhizotomy for intractable trigeminal neuralgia. J Clin Neurosci 2009;16:449-51.
6. Yang T, Lin M, Lee M, Weng H, Liao H. Percutaneous Trigeminal Nerve Radiofrequency Rhizotomy Guided by Computerized Tomography with Three-dimensional Image Reconstruction. Chang Gung Med J 2010;33:679-83
7. Cheng JS, Lim DA, Chang EF, Barbaro NM. A Review of Percutaneous Treatments for Trigeminal Neuralgia. Neurosurgery 2013;23:
8. Fransen P. Cost-effectiveness in the surgical treatments for trigeminal neuralgia. Acta Neurol Belg 2012;112(3):245-7.
9. Wang DD, Ouyang D, Englot DJ, Rolston JD, Molinaro AM, Ward M, et al. Trends in surgical treatment for trigeminal neuralgia in the United States of America from 1988 to 2008. J Clin Neurosci 2013; available at http://dx.doi.org/10.1016/j.jocn.2012.12.026-32.
10. Harden RN. Chronic neuropathic pain. Mechanisms, diagnosis, and treatment. Neurologist 2005; 11:111-6.
11. Bruyn GW. Nervus intermedius neuralgia (Hunt). Cephalalgia 1984; 4:71-5.
12. Goodwin, JG, Bajwa, ZH. Understanding the patient with chronic pain. In: Principles and practice of pain medicine, Warfield, CA, Bajwa, ZH (Eds), McGraw-Hill, USA 2004. p.55-9.
13. Headache classification subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 Suppl 1:S9.
14. Elias J, Kuniyoshi R, Carloni WV. Glossopharyngeal neuralgia associated with cardiac syncope. Arq Bras Cardiol 2002; 78:510-15.
15. Soh KB. The glossopharyngeal nerve, glossopharyngeal neuralgia and the Eagle's syndrome--current concepts and management. Singapore Med J 1999; 40:659-65.
16. Laha RK, Jannetta PJ. Glossopharyngeal neuralgia. J Neurosurg 1977; 47:316-22.
17. Patel A, Kassam A, Horowitz M, Chang YF. Microvascular decompression in the management of glossopharyngeal neuralgia: analysis of 217 cases. Neurosurgery 2002; 50:705-9.
18. Bruyn GW. Superior laryngeal neuralgia. Cephalalgia 1983; 3:235-9.
19. Watson P, Evans R. Cluster-tic syndrome. Headache 1985; 25:123-8.
20. Mulleners WM, Verhagen WI. Cluster-tic syndrome. Neurology 1996; 47:302-6.
21. Jaeger B, Singer E, Kroening R. Reflex sympathetic dystrophy of the face. Report of two cases and a review of the literature. Arch Neurol 1986; 43:693-8.
Published
2019-12-28
Section
Original Article