Acta Neurochirurgica

, Volume 122, Issue 3–4, pp 225–230 | Cite as

Patient's assessment of outcome after three surgical procedures for the management of trigeminal neuralgia

  • J. M. Zakrzewska
  • D. G. T. Thomas
Clinical Articles

Summary

Four hundred and seventy five patients with trigeminal neuralgia underwent cryotherapy (145), radiofrequency thermocoagulation (265) or microvascular decompression 65) and were then followed up for mean time of 45 months. Outcome of treatment was assessed not only by the clinicians but also by a postal questionnaire. The presence of anxiety and depression was determined and compared to 51 patients due to undergo surgery.

The median time to recurrence for the cryotherapy patients and the radiofrequency thermocoagulation patients were 6 and 24 months, respectively. At 5 years 38% of the microvascular decompression patients had had a recurrence of neuralgia. There was one operative death in the radiofrequency thermocoagulation group. Patients in all three groups were satisfied with their treatment but the questionnaires showed that clinicians under-report the recuccrence of pain and post operative complications. Pre-operatively depression and anxiety are high but post-operatively only 15% were depressed.

Patients need careful pre-operative assessment which includes the McGill Pain Questionnaire and they should be given a choice about which surgical method would be most suitable in their case. Printed information should be available to supplement the consultation. This would ensure the patients' expectations matched up with the results as they would be aware of possible outcomes.

Keywords

Trigeminal neuralgia cryotherapy radiofrequency thermocoagulation microvascular decompression 

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References

  1. 1.
    Apfelbaum RI (1977) A comparison of percutaneous radiofrequency trigeminal neurolysis and microvascular decompression of the trigeminal nerve for the treatment of tic douloureux. Neurosurgery 1: 16–21PubMedGoogle Scholar
  2. 2.
    Apfelbaum RI (1983) Surgery for tic douloureux. Clin Neurosurg 31: 351–368PubMedGoogle Scholar
  3. 3.
    Barnard D, Lloyd J, Evans J (1981) Cryoanalagesia in the management of chronic facial pain. J Max Fac Surg 9: 101–102Google Scholar
  4. 4.
    Breeze R, Ignelzi RJ (1982) Microvascular decompression for trigeminal neuralgia. Results with special reference to the late recurrance rate. J Neurosurg 57: 487–490PubMedGoogle Scholar
  5. 5.
    Bruchiel KJ, Steege TD, Howe JF, Loeser JD (1981) Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery 9: 111–118PubMedGoogle Scholar
  6. 6.
    Burchiel KJ, Clarke H, Haglund M, Loeser JD (1988) Long term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69: 35–38PubMedGoogle Scholar
  7. 7.
    Choi CR, Kang SK, Rha HK (1982) Percutaneous stereotactic thermocoagulation for trigeminal neuralgia. Appl Neurophysiol 45: 512–515PubMedGoogle Scholar
  8. 8.
    Ferguson GG, Brett DC, Peerless SJ, Barr HWK, Grivin JP (1981) Trigeminal neuralgia: a comparison of the results of percutaneous rhizotomy and microvascular decompression. Can J Neurol Sci 8: 207–213PubMedGoogle Scholar
  9. 9.
    Fritzpatrick R (1991) Surveys of patient satisfaction: 1. Important general considerations. BMJ 302: 886–889Google Scholar
  10. 10.
    Goss AN (1984) Peripheral cryoneurotomy in the treatment of trigeminal neuralgia. Aust Dent J 29: 222–224PubMedGoogle Scholar
  11. 11.
    Jannetta PJ (1976) Microsurgical approach to the trigeminal nerve for tic doloureux. In: Krayenbuhl HA (ed) Progress in neurological surgery, vol 7. Karger, Basel, pp 180–200Google Scholar
  12. 12.
    Jannetta PJ (1981) Vascular decompression in trigeminal neuralgia. In: Samii M, Jannetta PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York, pp 332–340Google Scholar
  13. 13.
    Kolluri S, Heros RC (1984) Microvascular decompression for trigeminal neuralgia. A five year follow-up study. Surg Neurol 22: 235–240PubMedGoogle Scholar
  14. 14.
    Latchaw JP, Hardy RW, Forsythe SB, Cook AF (1981) Trigeminal neuralgia treated by radiofrequency coagulation. J Neurosurg 59: 479–484Google Scholar
  15. 15.
    Melzack R (1975) The McGill pain questionnaire: major properties and scoring methods. Pain 1: 277–299PubMedGoogle Scholar
  16. 16.
    Melzack R, Terrence C, Fromm G, Amsel R (1986) Trigeminal neuralgia and atypical facial pain: use of the McGill Pain Questionnaire for discrimination and diagnosis. Pain 28: 297–302Google Scholar
  17. 17.
    Mittal B, Thomas DGT (1986) Controlled thermocoagulation in trigeminal neuralgia. J Neurol Neurosurg Psychiatry 49: 932–936PubMedGoogle Scholar
  18. 18.
    Morris J, Royle G (1988) Offering patients a choice of surgery for early breast cancer: a reduction in anxiety and depression in patients and their husbands. Soc Sci Med 26: 583–585PubMedGoogle Scholar
  19. 19.
    Nugent GR (1982) Technique and results of 800 percutaneous radiofrequency thermocoagulations for trigeminal neuralgia. Appl Neuophysiol 45: 504–507Google Scholar
  20. 20.
    Onofrio BB (1975) Radiofrequency percutaneous Gasserian ganglion lesions. Results in 140 patients with trigeminal pain. J Neurosurg 42: 132–139PubMedGoogle Scholar
  21. 21.
    Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG (1977) Design and analysis of randomised clinical trials requiring prolonged observation of each patient. 11 Analysis and examples. BJ Cancer 35: 1–39Google Scholar
  22. 22.
    Piatt JH, Wilkins RH (1984) Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 14: 462–471PubMedGoogle Scholar
  23. 23.
    Politis C, Adriaensen H, Bossuyt M, Fossion E (1988) The management of trigeminal neuralgia with cryotherapy. Acta Stomatol Belg 85: 197–205PubMedGoogle Scholar
  24. 24.
    Rawlinson E (1983) Quality of life after treatment for laryngeal cancer: the patient's viewpoint. Can J Radiography Radiother Nucl Med 14: 125–127Google Scholar
  25. 25.
    Sengupta RP, Stunden RJ (1977) Radiofrequency thermocoagulation of Gasserian ganglion and its rootlets for trigeminal neuralgia. BMJ 1: 142–143PubMedGoogle Scholar
  26. 26.
    Siegfried J (1977) 500 percutaneous thermocoagulations of the Gasserian ganglion for trigeminal pain. Surg Neurol 8: 126–131PubMedGoogle Scholar
  27. 27.
    Siegfried J (1981) Percutaneous controlled thermocoagulation of Gasserian ganglion in trigeminal neuralgia. Experiences with 1000 cases. In: Samii M, Jannetta PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York, pp 322–330Google Scholar
  28. 28.
    Sweet WH, Wespic JG (1974) Controlled thermocoagulatoin of trigeminal ganglion and rootlets for differential destruction of pain fibres. Part 1: trigeminal neuralgia. J Neurosurg 39: 143–156Google Scholar
  29. 29.
    Szapiro J, Sindou M, Szapiro J (1985) Prognostic factors in microvascular decompression for trigeminal neuralgia. Neurosurgery 17: 920–929PubMedGoogle Scholar
  30. 30.
    Tew JM, Keller JT (1977) The treatment of trigeminal neuralgia by percutaneous radiofrequency technique. Clin Neurosurg 24: 557–578PubMedGoogle Scholar
  31. 31.
    Van Loveren H, Tew JM, Keller JT, Nurre MA (1982) A 10 year experience in the treatment of trigeminal neuralgia comparison of percutaneous stereotoxic rhizotomy and posterior fossa exploration. J Neurosurg 57: 757–764PubMedGoogle Scholar
  32. 32.
    Zakrzewska JM (1991) Cryotherapy for trigeminal neuralgia: a ten year audit. Br J Oral Maxfac Surg 29: 1–4Google Scholar
  33. 33.
    Zakrzewska JM, Nally FF (1988) The role of cryotherapy (cryoanalgesia) in the management of paroxysmal trigeminal neuralgia: a six year experience. Br J Oral Maxfac Surg 26: 18–25Google Scholar
  34. 34.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67: 361–370PubMedGoogle Scholar
  35. 35.
    Zorman G, Wilson CB (1984) Outcome following microsurgical vascular decompression or partial sensory rhizotomy in 125 cases of trigeminal neuralgia. Neurology 34: 1362–1365PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • J. M. Zakrzewska
    • 1
    • 2
  • D. G. T. Thomas
    • 2
  1. 1.Joint Department of Maxillofacial Surgery and Oral MedicineEastman Dental HospitalLondon
  2. 2.Department of Neurological Surgery, Institute of NeurologyThe National HospitalLondonUK

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