Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study

Abstract

Introduction Trigeminal neuralgia (TN) often called as ''Tic douloureux'' is a syndrome characterized by paroxysmal facial pain, is one of the most painful and debilitating craniofacial pain disorders. The controversy regarding the etiology and treatment of TN still exists. Objective To evaluate the effectiveness of percutaneous radiofrequency rhizotomy (PRR) for TN, after failure of pharmacological management. Method A nonrandomized, non comparative, descriptive, in vivo study of 15 patients with TN of maxillary and mandibular divisions of trigeminal nerve and patients with pain refractory to pharmacological management were done. It was performed as an O.P.D procedure. A routine follow up was done in all cases for 1 year. Results In a total of 15 patients, 8 female and 7 male patients were enrolled for the study. Early pain relief (immediately, postoperatively to 6 month) classified as excellent or good (successful), occurred in 12 of 15 patients (80 %). Fair or poor pain relief (unsuccessful) occurred in three patients (20 %).There was no mortalities and no major morbidity. Summary It was found that surgical treatment with PRR is a safe and effective way to manage patients with TN in whom pharmacologic therapy is either ineffective or not tolerated, with low side effects which are well tolerated.

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

“…Nanjappa et al stated that in their study, the majority was in between 51 -60 years. 16 In our study, there was 34.6% male and 65.4% female patients and female to male ratio was 1.9:1. These findings are similar to a study by Hang et al, who reported 41.4% male and 58.6% female and a female to male of 1.42:1.…”

“…This is in accordance with the study by Nanjappa et al, which states that the average age of onset of the trigeminal neuralgia is 53 years. 16 Wang et al reported the mean age of 63 years in patients who presented with trigeminal neuralgia and underwent microvascular decompression. 11 The majority of the patients in our study were in 46 -55 years (n = 43, 39.09%) and 56 -65 years (n = 44, 40.00%) group.…”

“…Nanjappa et al performed rhizotomy on fifteen patients and reported that 80% of the patients showed excellent pain relief after a follow-up of six months. 16 According to Xie et al 87% of the patients reported pain relief after undergoing rhizotomy. 19 In our study, 12.7% of the patients showed mild improvement and 7.3% showed no improvement.In a study by Kanpolat et al, the 97.6% of the patients had complete pain relief immediately after the procedure, but at the end of six months, 7.7% of the patients started feeling again and again.…”

Human Skull Base Asymmetry Analysis

“…Also, one of the pathways of spread of a nasopharyngeal carcinoma is through this foramen (Chong et al, 1996). Additionally, the mandibular nerve passes through FO at which site it is the target site for percutaneous trigeminal rhizotomy in the management of trigeminal neuralgia (Nanjappa et al, 2013). Anthropological researches have investigated differences in the symmetry of the skull base in relation to sex, but statistically significant differences were not found (Ras et al).…”

The changing face of trigeminal neuralgia—A narrative review

“…57 Initial pain relief (around 90%) across these is approximately equal, but each one is associated with different rates of recurrence and complications. [194][195][196][197][198][199] With the large difference in success rates reported across centers for the same procedures, it is hard to unequivocally recommend a superior intervention. Radiofrequency thermocoagulation reaches high rates of pain relief but is associated with high frequencies of facial and corneal numbness.…”