Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis

J Neurosurg. 2013 Feb;118(2):329-36. doi: 10.3171/2012.9.JNS1226. Epub 2012 Nov 2.

Abstract

Object: Patients with trigeminal neuralgia due to multiple sclerosis (TN-MS) and idiopathic TN (ITN) who underwent glycerol rhizotomy (GR) and radiofrequency thermocoagulation with glycerol rhizotomy (RFTC-GR) were compared to investigate the effectiveness of these percutaneous ablative procedures in the TN-MS population.

Methods: Between 1998 and 2010, 822 patients with typical TN were evaluated; 63 (8%) had TN-MS and 759 (92%) had ITN. Pain relief comparisons were made between 22 GR procedures in patients with TN-MS and 470 GR procedures in patients with ITN; 50 RFTC-GR procedures in patients with TN-MS and 287 RFTC-GR procedures in patients with ITN were compared. Analysis of time to recurrence included only procedures that achieved complete pain relief without medications.

Results: After 15 of the GR procedures (68%) in patients with TN-MS and 315 of the procedures (67%) in those with ITN, the patients were pain free without medications (p = 0.736). After 36 of the RFTC-GR procedures (72%) in patients with TN-MS and 210 of the procedures (73%) in those with ITN, the patients were pain free without medications (p = 0.657). The difference in pain relief between GR and RFTC-GR for patients with TN-MS was not significant (p = 0.447). The median time to failure of GR was 20 months in patients with TN-MS compared with 25 months in those with ITN (p = 0.403). The median time to failure of RFTC-GR was 26 months in the TN-MS population compared with 21 months in the ITN population (p = 0.449). Patients with TN-MS experienced similar times to recurrence whether they were treated with GR or RFTC-GR (p = 0.431).

Conclusions: Pain relief and durability of relief outcomes of GR and RFTC-GR were similar in patients with TN-MS and ITN, reinforcing their use as preferred treatments of TN-MS. The GR and RFTC-GR achieved comparable outcomes in patients with TN-MS, suggesting that both can be used to good effect.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Catheter Ablation / methods*
  • Electrocoagulation / methods*
  • Facial Pain / complications
  • Facial Pain / surgery
  • Female
  • Follow-Up Studies
  • Glycerol / therapeutic use*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Postoperative Complications
  • Recurrence
  • Retrospective Studies
  • Rhizotomy / methods*
  • Solvents / therapeutic use
  • Trigeminal Neuralgia / complications
  • Trigeminal Neuralgia / surgery*

Substances

  • Solvents
  • Glycerol