Carolina Neurosurgery & Spine Associates
Trigeminal Neuralgia Study
Originally published Summer 2001

In an effort to assess response to various therapies here in Charlotte, Carolina Neurosurgery & Spine Associates conducted chart reviews and patient contacts were performed to evaluate patients treated in our clinic over the last four to five years. Our reviews included patients who were treated with microvascular decompression, or rhizolysis with glycerol or radiofrequency. Response to therapy at the time of last follow-up was assessed and graded on a 4 point scale, as follows:

An initial chart review involved an analysis of consecutively treated patients over a three year period. Of 42 patients who underwent microvascular decompression, 93% reported an excellent or good response. Favorable
(excellent/good) response rates in 24 patients who had glycerol and 12 patients who had radiofrequency rhizolysis were 63% and 75%, respectively. All procedures were well tolerated. A higher degree of numbness and paresthesias was noted in patients who underwent glycerol or radiofrequency rhizolysis. In addition,
Excellent
Assigned to patients who experienced complete relief of their pain and no longer were requiring pain medicines. These patients may have been experiencing very mild numbness or paresthesias.
Good
Assigned to patients who experienced complete relief of their pain and were free of medicines but were experiencing definite numbness or paresthesias, which they considered to be quite tolerable.
Fair
Assigned to patients who experienced very minimal or very little pain after the procedure but were still requiring some medications. These patients may or may not have been experiencing numbness or paresthesias/dysesthesias.
Poor
Assigned to patients who experienced no beneficial response to treatment, poor pain relief and/or development of a severe and troubling numbness or dysesthesias.
some dysesthesias were noted in this population. In particular, a single patient developed an unusual syndrome known as anesthesia dolorosa. This disorder is characterized by severe, painful numbness which is exceedingly difficult to treat. This condition is a known and unpredictable complication of rhizolysis and tends to be more likely in patients undergoing radiofrequency lesioning.

On the basis of our initial chart review, we conducted a broader chart analysis and phone interview of patients who had been treated with microvascular decompression. A series of 60 consecutively treated patients over a 5-year period was analyzed. Multiple attempts were made to contact all patients. Thirty-three (55%) of the patients that we treated were successfully contacted. Seventy percent of patients interviewed stated that they had experienced relief of their pain with medicines at the time of diagnosis. Of those patients who initia
lly responded to medicines, the median duration of relief was three years. At the time of surgery, 85% of the responders were still taking medicines for trigeminal neuralgia. Only 11% of those patients, however, reported experiencing any relief with their medicines just prior to surgery. The majority of patients reported medicine related side effects, including drowsiness, gait problems, fatigue, and/or blurred vision. The median duration of symptoms prior to surgery was 24 months. The average post surgical follow up was 31.3 months with a median follow up of 30 months. At the time of assessment, 76% and 15% of patients reported excellent and good responses to the procedure, respectively. Six percent of patients reported a fair response. There were no patients who reported a poor response. The majority of patients (88%) reported very rapid relief of their symptoms after surgery, with 88% stating that they had complete relief of their pain within days of their procedure.

A chart review was conducted to assess response to therapy for patients who could not be contacted by phone or mail. Final office visits were analyzed for these individuals. The average time between the patient’s last visit to our office and their procedure was 5.4 months. Chart analysis of this subgroup of patients showed that 82% of patients were experiencing excellent relief of their pain and 4% reported a good response at last follow-up. Thirteen percent of patients had a fair response, based on these reviews. There were no poor responses.

Patients undergoing microvascular decompression had remarkably few side effects. There were no permanent neurologic deficits aside from a few patients who reported varying degrees of facial hypesthesia. No episode of painful facial numbness was reported. One patient experienced wound discomfort related to neuroma formation and this symptom responded to trigger point injections. Three patients experienced transient cranial nerve IV palsies which resolved completely.


Summary

In summary, trigeminal neuralgia is a relatively uncommon but extremely painful affliction characterized by lancinating, shock-like pain within the trigeminal distribution. The majority of patients experience excellent relief of their symptoms with medicines initially, but most patients will ultimately become refractory to medicines and/or experience significant medicine-related side effects. Surgical procedures can offer patients with medically refractory trigeminal neuralgia excellent relief of their symptoms with low complication rates. If you have any questions regarding the trigeminal neuralgia program at Carolina Neurosurgery & Spine Associates, please feel free to contact Anthony Asher, M.D., F.A.C.S.




Current Issue -Subscribe - Unsubscribe - Article Archive - cnsa.com

© 2001 Carolina Neurosurgery & Spine Associates