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  • Effectiveness of Repeat Radiofrequency Thermocoagulation in the Treatment of Recurrent Trigeminal Neuralgia

    Final Number:
    132

    Authors:
    Matthew Bender; Gustavo Pradilla MD; Sachin Batra MD, MPH; Alfred Pokmeng See; Neal Bhutiani BS; Carol James BS; Michael Lim MD; Benjamin S. Carson MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Radiofrequency thermocoagulation (RFTC) is routinely used in the treatment of trigeminal neuralgia (TN). Pain relief achieved lasts 3-5 years in most patients after the first treatment but the outcomes of subsequent RFTC interventions have not been sufficiently studied.

    Methods: Between 1998 and 2010, 412 patients with TN underwent 728 RFTC procedures. Outcomes were available for 638 RFTCs (87.6%), 90 RFTCs (12.4%) were excluded due to limited follow-up. Comparisons were made between 502 first and second RFTC (RFTC 1&2) and 136 third or additional RFTCs (RFTC 3+). Pain relief was assessed using the Boulder-Stanford (B-S) pain scale and compared with a Fisher’s exact test. Durability was assessed by determining median time to treatment failure (B-S scale 3 or 4) for all procedures that achieved good pain relief outcomes (B-S 1 or 2, n=510; 315 failures, 195 censored). Predictors of treatment failure were assessed by multivariate Cox-regression analyses adjusting for multiple procedures within same patient.

    Results: Pain relief outcomes after RFTC 1&2 were excellent in 346 (68.9%), moderate in 67 (13.4%), mild in 38 (7.6%), and unchanged in 51 (10.1%), while after RFTC3+ excellent pain relief was achieved in 80 patients (58.8%), moderate in 17 (12.5%), mild in 11 (8.1%), and unchanged in 28 (20.6%) (p = 0.015). Median time to RFTC failure was 513 days in RFTC1&2 (95% CI 440-608) compared with 456 days in RFTC3+ (95% CI 333-552, Chi-square = 0.0163). Prior RFTC and male gender were associated with a 44.5% (HR 1.445, 95% CI 1.094-1.908) and a 27.7% (HR 1.277, 95% CI 1.014-1.607) increase in risk of failure, respectively.

    Conclusions: Pain relief and durability after RFTC significantly decreased in patients undergoing a third or subsequent RFTC as compared with patients undergoing a first or second procedure in the cohort studied. Male gender and previous RFTC were associated with poor pain relief and early treatment failure.

    Patient Care: This study provides further evidence of the efficacy of repeated radiofrequency treatments in patients with recurrent trigeminal neuralgia.

    Learning Objectives: To described the indications for radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. To understand the efficacy of repeated radiofrequency thermocoagulation in patients with recurrent trigeminal neuralgia.

    References:

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