Abstract
Introduction
With recent development in the treatment of trigeminal neuralgia (TN), percutaneous stereotactic rhizotomy is being widely used as an interventional technique. The purpose of this study was to find the recurrence rate of TN in patients who were treated with stereotactic rhizotomy at 80 degrees C for 90 seconds, in a tertiary care set up in a developing country.
Methodology
A retrospective cohort study was conducted at Shifa International Hospital, Islamabad, Pakistan from September 2016 to August 31, 2021. A total of 57 patients (19 males and 38 females) aged 27-90 years old, whose MRI of the brain had ruled out organic or structural pathologies, and who fulfilled the International Classification of Headache Disorders, 3rd edition for TN were recruited for the study. Of these patients, 51 underwent radiofrequency ablation (RFA) of the trigeminal ganglion (one or more branches of the trigeminal nerve (cranial nerve V (CN V)) in the operation theater. Patients having concomitant comorbid conditions like brain tumors, vascular pathologies, or coagulopathies, those who had previously undergone trigeminal ganglion neurolysis with either alcohol or phenol, who were lost to follow-up before the completion of the six months or had not visited back after the procedure, and those on oral anticoagulants and the ones declared high risk or American Society of Anesthesiologists (ASA) 3 and above for general anesthesia were excluded. Ethical approval was obtained and data were collected from the medical records department. The pain was recorded using the Numeric Rating Scale and recurrence was recorded from the follow-up visits of the patient over at least 12 months.
Results
Out of 51 patients, three patients who underwent RFA reported recurrence of the same problem for which they had initially reported to the pain clinic and were treated again with RFA. Five patients came back with the neuralgia of a different but contiguous branch of the same Gasserian ganglion opted for the RFA and were treated with no subsequent recurrences. The initial pain relief rate was 84.31%. At the end of the five-year study period, 16 patients reported variable degrees of sensory deficit, and two patients experienced non-debilitating unilateral reversible motor weakness of the jaw. One patient experienced keratitis due to unintentional loss of corneal reflex and subsequent ipsilateral loss of vision.
Conclusion
RFA is one of the leading treatment options for TN, with lower recurrence at higher temperatures of the radiofrequency electrode, at the cost of more significant sensory and motor deficits.