A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy

1995 ◽  
Vol 83 (6) ◽  
pp. 989-993 ◽  
Author(s):  
Jamal M. Taha ◽  
John M. Tew ◽  
C. Ralph Buncher
Keyword(s):  
Trigeminal Neuralgia ◽  
Target Lesion ◽  
Long Term Results ◽  
Sensory Loss ◽  
Content Type ◽  
Kaplan Meier ◽  
Corneal Reflex ◽  
Trigger Zone

✓ There is a lack of prospective studies for the long-term results of percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of patients with trigeminal neuralgia. The authors present results in 154 consecutive patients with trigeminal neuralgia treated by PSR and prospectively followed for 15 years. Ninety-nine percent of the patients obtained initial pain relief after one PSR. Dysesthesia occurred in 31 patients (23%): in 7% with mild initial hypalgesia; in 15% with dense hypalgesia; and in 36% with analgesia. Dysesthesia was mild and did not require treatment in most patients. The corneal reflex was absent or depressed in 29 patients, and keratitis developed in three patients. In 19 of 22 patients with trigeminal motor weakness, the paresis resolved within 1 year. Of 33 patients who had pain recurrence, 10 patients had pain that was mild or controlled with medications, and 23 patients required additional surgical treatment. The authors estimated using Kaplan—Meier analysis that the 14-year recurrence rate was 25% in the total group: 60% in patients with mild hypalgesia, 25% in those with dense hypalgesia, and 20% in those with analgesia. Timing of pain recurrence varied according to the degree of sensory loss. All pain recurrences in patients with mild hypalgesia occurred within 4 years after surgery; 10% more of the patients with dense hypalgesia had pain recurrences within the first 10 years compared with patients with analgesia. The median pain-free survival rate was 32 months for patients with mild hypalgesia and more than 15 years for patients with either analgesia or dense hypalgesia. Of the 100 patients followed for 15 years after one or two PSR procedures, 95 patients (95%) rated the procedure excellent (77 patients) or good (18 patients). The authors conclude that PSR is an effective, safe treatment for trigeminal neuralgia. Dense hypalgesia in the painful trigger zone, rather than analgesia, should be the target lesion.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results

1990 ◽  
Vol 73 (2) ◽  
pp. 212-216 ◽  
Author(s):  
Takamitsu Fujimaki ◽  
Takanori Fukushima ◽  
Shinichiro Miyazaki
Keyword(s):  
Trigeminal Neuralgia ◽  
Content Type ◽  
Kaplan Meier ◽  
Glycerol Injection ◽  
Sensory Disturbances ◽  
Long Term Follow Up ◽  
The Face ◽  
Median Pain

✓ The results in 122 patients with trigeminal neuralgia who underwent percutaneous retrogasserian glycerol injection are presented. Eighty patients were followed from 38 to 54 months. The recurrence rate at 54 months was 72% (Kaplan-Meier analysis), and the median pain-free interval was 32 months. Complications associated with the procedure were significantly high: 63% of the patients had definite hypesthesia of the face and 29% had unpleasant dysesthesias, including two cases of anesthesia dolorosa. Sensory disturbances were most frequent in patients who had received a previous alcohol block procedure. Among the patients without previous peripheral procedures, 50% developed sensory disturbances. Because of the high rates of recurrence and sensory disturbances, the authors prefer microvascular decompression for the management of trigeminal neuralgia.

Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia

1990 ◽  
Vol 72 (1) ◽  
pp. 55-58 ◽  
Author(s):  
K. Singh Sahni ◽  
Daniel R. Pieper ◽  
Randy Anderson ◽  
Nevan G. Baldwin
Keyword(s):  
Trigeminal Neuralgia ◽  
Corneal Ulceration ◽  
General Belief ◽  
Content Type ◽  
Kaplan Meier ◽  
Classical Trigeminal Neuralgia ◽  
Significant Difference ◽  
Glycerol Rhizolysis

✓ The effects of percutaneous retrogasserian glycerol rhizolysis were observed in a population of 58 cases of classical trigeminal neuralgia. The follow-up period ranged from 7 to 52 months postoperatively. It was noted that 84% of the patients had immediate relief of pain. The overall recurrence rate was 29%. Based on Kaplan-Meier survival curves, the overall half-life (T½) of this procedure was 16 months. Although none of the patients developed anesthesia dolorosa or corneal ulceration, one group of patients developed either a clinical or subclinical persistent “minimal hypesthesia.” In these there was a statistically significant difference in the T½ associated with this procedure (p = 0.01). This finding suggests that, contrary to the general belief, persistent hypesthesia after glycerol rhizolysis is a negative indicator of long-term success.

Long-Term Results of Percutaneous Retrogasserian Thermorhizotomy for “Essential” Trigeminal Neuralgia: Considerations in 1000 Consecutive Patients

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 783-787 ◽  
Author(s):  
Giovanni Broggi ◽  
Angelo Franzini ◽  
Giovanni Lasio ◽  
Cesare Giorgi ◽  
Domenico Servello
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Sensory Deficit ◽  
Long Term Results ◽  
Cure Rate ◽  
Corneal Reflex ◽  
Permanent Morbidity

Abstract Long-term results (average follow-up, 9.3 years) obtained in 1000 consecutive patients suffering from cryptogenetic (“essential”) trigeminal neuralgia treated with percutaneous thermorhizotomy are analyzed. Pain relief was obtained in 95% of the treated patients. Permanent morbidity was as follows: masseter weakness in 105 patients; oculomotor palsies in 5 patients; weakening of the corneal reflex in 197 patients, 6 of whom requested an ocular operation for keratitis; and painful dysesthesia in 52 patients, 15 of whom developed a painful anesthesia syndrome. There was a recurrence rate of 18.1%, and a correlation between postoperative sensory deficit and the cure rate was found. These results are discussed and compared to the results obtained with different techniques.

scholarly journals Long-Term Results after Glycerol Rhizotomy for Multiple Sclerosis-Related Trigeminal Neuralgia

1994 ◽  
Vol 21 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
David J. Bissonette
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Surgical Procedures ◽  
Pain Control ◽  
Long Term Results ◽  
Sensory Loss ◽  
Single Patient

Abstract:Percutaneous retrogasserian glycerol rhizotomy (PRGR) was used during an 11-year interval in 53 patients with typical trigeminal neuralgia associated with multiple sclerosis. All patients had failed extensive medical trials prior to PRGR. Long-term (median follow-up, 36 months) complete pain relief (no further medication) was achieved in 29 (59%) of 49 evaluable patients. Eight patients (16%) had satisfactory pain control but required occasional medication. Twelve patients (25%) had initial unsatisfactory results with inadequate pain relief; nine underwent alternative surgical procedures. Sixteen patients (30%) subsequently required repeat glycerol rhizotomies to reachieve pain control. Twenty-seven patients (60% of 45 patients evaluated for this finding) retained normal trigeminal sensation after injection. Major trigeminal sensory loss developed in a single patient who had four glycerol rhizotomies over a 25-month interval. No patient developed deafferentation pain. We believe that PRGR is a low-morbidity, effective, and repeatable surgical procedure for the management of trigeminal neuralgia in the setting of multiple sclerosis.

Long-term results of Gasserian ganglion electrocoagulation

1975 ◽  
Vol 42 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Jürgen Menzel ◽  
Wolfgang Piotrowski ◽  
Helmut Penzholz
Keyword(s):  
Trigeminal Neuralgia ◽  
Long Term Results ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Follow Up Study ◽  
Fine Print

✓ This report is a follow-up study of 315 patients under 46 years old who suffered from trigeminal neuralgia and were treated by electrocoagulation of the Gasserian ganglion. The average follow-up period was 12.7 years, the maximum 33 years. Eighty percent had a return of pain, but 96.7% ultimately attained freedom from pain after repeat electrocoagulation.

Percutaneous retrogasserian glycerol rhizotomy for treatment of trigeminal neuralgia

1986 ◽  
Vol 65 (1) ◽  
pp. 28-31 ◽  
Author(s):  
David W. Beck ◽  
Jeffrey J. Olson ◽  
Edward J. Urig
Keyword(s):  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Sensory Loss ◽  
Additional Patient ◽  
Complete Relief ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Clinical Series ◽  
Corneal Reflex

✓ The treatment of trigeminal neuralgia by percutaneous retrogasserian glycerol rhizotomy was assessed in a series of 58 patients with a follow-up period ranging from 2 to 40 months postoperatively. All patients were considered medical failures prior to the procedure. Idiopathic trigeminal neuralgia was the diagnosis in 54 patients, and four patients had trigeminal neuralgia associated with multiple sclerosis. Forty-two patients (72%) reported complete relief from the procedure and are taking no medications. Four patients (7%) are much improved and require only minimal drug therapy. Twelve patients (21%) were considered treatment failures. The recurrence rate after initial relief of symptoms was 11%. Ten patients (17%) noticed a mild decrease in facial sensation following the procedure, and one additional patient had a profound sensory loss including loss of corneal reflex. The authors conclude that, while percutaneous retrogasserian glycerol rhizotomy may be useful in the treatment of trigeminal neuralgia, more clinical series and documentation of recurrence rate and complications are needed before any firm conclusions can be reached as to the efficacy of this therapy.

Microvascular Transposition Without Teflon: A Single Institution's 17-Year Experience Treating Trigeminal Neuralgia

2021 ◽  
Vol 20 (4) ◽  
pp. 397-405
Author(s):  
Andrew R Pines ◽  
Richard J Butterfield ◽  
Evelyn L Turcotte ◽  
Jose O Garcia ◽  
Noel De Lucia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Postoperative Pain ◽  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Microvascular Decompression ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Trigeminal Nerve Root

Abstract BACKGROUND Trigeminal neuralgia (TN) refractory to medical management is often treated with microvascular decompression (MVD) involving the intracranial placement of Teflon. The placement of Teflon is an effective treatment, but does apply distributed pressure to the nerve and has been associated with pain recurrence. OBJECTIVE To report the rate of postoperative pain recurrence in TN patients who underwent MVD surgery using a transposition technique with fibrin glue without Teflon. METHODS Patients were eligible for our study if they were diagnosed with TN, did not have multiple sclerosis, and had an offending vessel that was identified and transposed with fibrin glue at our institution. All eligible patients were given a follow-up survey. We used a Kaplan-Meier (KM) model to estimate overall pain recurrence. RESULTS A total of 102 patients met inclusion criteria, of which 85 (83%) responded to our survey. Overall, 76 (89.4%) participants responded as having no pain recurrence. Approximately 1-yr pain-free KM estimates were 94.1% (n = 83), 5-yr pain-free KM estimates were 94.1% (n = 53), and 10-yr pain-free KM estimates were 83.0% (n = 23). CONCLUSION Treatment for TN with an MVD transposition technique using fibrin glue may avoid some cases of pain recurrence. The percentage of patients in our cohort who remained pain free at a maximum of 17 yr follow-up is on the high end of pain-free rates reported by MVD studies using Teflon. These results indicate that a transposition technique that emphasizes removing any compression near the trigeminal nerve root provides long-term pain-free rates for patients with TN.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

Reinforcement Rings for Deficient Acetabular Bone in Revision Surgery: Long-Term Results

1997 ◽  
Vol 7 (2) ◽  
pp. 57-64 ◽  
Author(s):  
E. Garcia-Cimbrelo ◽  
J. Alonso-Biarge ◽  
J. Cordero-Ampuero
Keyword(s):  
Revision Surgery ◽  
Clinical Results ◽  
Long Term Results ◽  
Cumulative Probability ◽  
Metal Ring ◽  
Kaplan Meier ◽  
Medial Migration ◽  
Cemented Cup

This study analyzes the long-term results of 23 metal ring supports used in revision surgery since 1979. Only a metallic ring and a cemented cup were used in this series. Bone grafts and cementless cups were excluded from this study. One deep infection was excluded from the follow-up study. In the 22 cases analyzed, the mean follow-up period was 10 years for all cases and 12.2 years for unrevised cases. Bone defects according to the AAOS classification were: Grade 1, 1 case, Grade 2, 1 case, Grade 3, 10 cases, and Grade 4, 10 cases. A Müller ring was indicated in an anterior or medial wall defect (12 cases) and a Burch-Schneider ring was indicated in an anterior or posterior column defect or in pelvic discontinuity (10 cases). The clinical results were good in 8 cases, fair in 8 cases, and poor in 6 cases. Six cases were rerevised or removed, resulting in a total cumulative probability of rerevison or removal of 23.8% after 10 years according to the Kaplan-Meier analysis. Postoperatively, 18 cases had neutral rings, 2 cases had horizontal rings, and 2 cases had vertical rings. Radiological cup migration was found in 12 cases, resulting in a total cumulative probability of migration of 56.8% after 13 years according to the Kaplan-Meier analysis. Changes in the acetabular angle were present in 2 cases, vertical migration in 12 cases, and medial migration in 10 cases. Our data suggest that the metal ring and cemented cup alone could be used for salvage surgery in elderly patients and in low-demand patients. Possibly, adding bone graft could improve these results.

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