Introduction: Choosing the optimal treatment modality for refractory trigeminal neuralgia (TN) is multifactorial, and has not been well defined in the literature. In this review we specifically explore the role of three factors in determining the treatment modality: age, recurrence rate, and cost.
Methods: Retrospective chart review of patients who underwent percutaneous Radiofrequency Rhizotomy (RFR), Stereotactic Radiosurgery (SRS) and Microvascular Decompressions (MVD) for trigeminal neuralgia between the periods of 2003 to 2011.
Results: A total of 95 procedures were identified, including 46 MVD’s, 27 RFR, and 22 SRS. The average age of patients who had: (1) MVD was 52±12 (24-75), (2) SRS was 67±15 (25-85), and (3) RFR was 71±11 (51-89). Preliminary results suggest recurrence of symptoms in 3/46 patients treated with MVD, 3/21 treated with RF, and none in the patients initially treated with SRS. The total charges for the 3 procedures were (mean ± SD): 56 ± 2.5x1000, 1.3 ± 0.8x1000, and 44±1.6x1000 US dollars, for MVD, RS, and SRS respectively. Actual payments varied depending on health insurance coverage.
Conclusions: Despite their unique advantages, the charges for the 3 procedures vary considerably. MVD was the most expensive procedure, and was least likely associated with facial numbness. SRS and RFR were recommended for older patients. SRS is expensive, and requires several weeks before symptomatic improvement. RFR is associated with immediate response, performed as an outpatient, and is the cheapest of the 3 procedures; however it is associated with the highest rate of recurrence.
Patient Care: Better patient selection and more informative counselling of patient on available management options based on current evidence. This will improve the decision making process for both the patients and the treating physician when treating refractroy TN.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of cost involved, age and recurrence rate factors in choosing a suitable management options 2) Discuss the pros and cons for each of the available treatment modlities, 3) Identify an cost effective treatment for refractory TN.