Results

Using percutaneous radiofrequency rhizotomy, the senior author has treated more than 2000 patients who had trigeminal neuralgia (21). The initial 700 cases were performed with a straight electrode and the last 1300 cases with the curved electrode. Pain, which averaged 8 yr in duration, was treated with medical and procedural interventions. Medications included carbamazepine (Tegre-tol), baclofen (Lioresal), and diphenylhydantoin (Dilantin). Interventions included nerve avulsion, alcohol injection, subtotal intracranial rhizotomy, gan-glionectomy, microvascular decompression, and percutaneous RFL.

Although medical treatment provided initial relief, pain recurred in 75% of patients. In this series, 35% of patients had undergone a previous surgical procedure; this group was characterized by a 2:1 ratio of women to men, with an overwhelming occurrence in the right trigeminal nerves. The afflicted divisions were as follows: the first in 1%, the second in 16%, the third in 16%, the first and second in 15%, the second and third in 39%, and all three divisions in 13% (Table 1). Early outcomes were graded on pain relief and levels of dysesthesia and paresthesia (Table 2). The vast majority of patients reported good pain relief, absent or minor dysesthesias, and absent or minor paresthesias (21). Compared with a straight electrode, a curved electrode reduced complications by more than 50%, including dysesthesias, anesthesia dolorosa, absent corneal reflexes, trigeminal pain, keratitis, diplopia, and masseter weakness (Table 3). There were no deaths and no intracranial hemorrhages. There was a 0.1% incidence of carotid cavernous fistula, 0.2% meningitis, 2% keratitis, 1.2% diplopia, 6% absent corneal reflex, and 1% anesthesia dolorosa (Table 4). Motor weakness decreased from 24 to 7% when a curved electrode was used.

Ophthalmologic complications include diplopia caused by damage to the abducens, trochlear, and oculomotor nerves; these motor nerve injuries were

Table 1

Characteristics of 1200 Patients Who Underwent Percutaneous Radiofrequency Rhizotomy a

Characteristic %

Female 63

Male 37 Side of coagulation

Right 60

Bilateral 5 Division of trigeminal nerve involved

First 1

Second 16

Third 16

First and second 15

Second and third 39

First, second, and third 13

a Patients (mean age 65 yr) with multiple sclerosis excluded. From ref. 21, copyright 1995 W. B. Saunders.

Table 2

Early Results of Percutaneous Radiofrequency Rhizotomy in 1200 Patientsa

Table 2

Early Results of Percutaneous Radiofrequency Rhizotomy in 1200 Patientsa

Result

Description

%

Excellent

No tic pain, dysesthesia, or troublesome paresthesia

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