Article
Fractional thermocoagulation of the trigeminal ganglion in the treatment of refractory trigeminal neuralgia
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Authors
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Apostolos Chatzikalfas
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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M. Beier
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
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Athanasios Koulousakis
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln
| Published: | June 2, 2015 |
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Outline
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Objective: According to DGN and AWMF there are different treatments of refractory trigeminal neuralgia, mainly MVD and thermokoagulation. The efficiency of both methods is known to be around 90%. In our hospital we have been practicing fractional thermocoagulation for more than 40 years. We investigated retrospectively the amount of treatments we preformed since 2007 to find a correlation between the cause of the trigeminal neuralgia and the relapse rate as well as between the preop./postop barrier of painful stimulation and the time a relapse reoccurs.
Method: Since 2007 we treated more than 209 patients. More than 366 thermocoagulations were carried out. 57% were female and 43% male. The average age was 66.4 years. Most commonly affected branch was the 3rd. 61% had an idiopathic neuralgia. 21% had MS, 12% had microvascular compression, 4% were tumor-related and 2% other related cause. In each patient 3 coagulations were performed intraoperatively. At 60 ° C, then at 70 ° C and then at 90° C.
Results: All patients had postop. no pain or a 90% reduction of their pain. The overall complication rate was less than 1%. The average barrier of painful stimulation was preop. at 0.3 V and postop. at 0.75V. Women have a recurrence rate of 27.5% and men a 32.6%. Patients with MS had a recurrence rate of 48%, patients with idiopathic trigeminal neuralgia one of 24.4%. Patients with vascular compression of the trigeminal nerve a rate of 32%, out of those who already had a MVD there was a recurrence rate of 31.25% and patients without MVD had almost the same recurrence rate of 33.3%. From the patients where a thermocoagulation was preformed women with MS had an average 'pain free' period of 22 months, men of 16.2 months. Women with idiopathic neuralgia 15.94 months and men 15.74 months. In patients with proven vascular compression, women with MVD 40.6 months and men 45.61 months. In patients with established vascular compression but without MVD women had an average ‘pain free’ period of 12.83 months and no residual pain occurred in men.
Conclusions: The fractional thermocoagulation, after the technical improvement, is a safe therapy combining a high success rate with a low complication rate. It shows a direct correlation between the preop./postop. barrier of painful stimulation and the relapse rate as well as the period in which a relapse is expected to occur. There seems to be no significant difference in the relapse rate between patients with vascular compression who had a MVD and the ones who didn’t.
