TY - JOUR
T1 - Outcome of Surgical Treatments of Chronic Pain Caused by Trigeminal Neuropathy
AU - Basha, Ahmed Kamel Mohamed Moner
AU - Simry, Hisham Abdelsalam Mohamed
AU - Abdelbar, Ahmad Elsayed
AU - Sabry, Hatem
AU - Raslan, Ahmed M.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/2
Y1 - 2023/2
N2 - Background: Trigeminal neuropathy represents a subset of several facial pain syndromes that are difficult to diagnose and treat. Although many surgical modalities are available, outcomes remain suboptimal. The aim of this study is to present our experience in management of trigeminal neuropathy with a focus on the effectiveness and long-term efficacy of the different surgical procedures. Methods: A single-center retrospective cohort study was conducted from December 2012 until February 2020. Results: Twenty-eight patients (19 females, 9 males) were included in this study. They had 40 surgical interventions. At last follow-up, 1 patient (33.3%) treated by spinal cord stimulation (SCS) had no pain recurrence and 2 patients (66.6%) had their devices removed because of therapeutic failure. Median time to pain recurrence after SCS was 19.5 months (interquartile range [IQR], 29.79 months). Six patients were treated with peripheral nerve stimulation (PNS). At last follow-up, 2 patients had satisfactory pain relief, whereas half of the patients had no improvement. For the 17 patients treated with computed tomography–guided trigeminal tractotomy/nucleotomy, true failure occurred 7 times in 6 patients. Median time to pain recurrence was 5.6 months (IQR, 6.2). Of the 6 patients treated with caudalis DREZ, 3 (50%) had satisfactory pain relief for >1 year and the median time to pain recurrence was 3.9 months (IQR, 29.53). Conclusions: Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. The long-term efficacy of available interventions does not meet patients' satisfaction. More organized prospective studies with longer follow-up are needed to define the patient population best served by each surgical modality.
AB - Background: Trigeminal neuropathy represents a subset of several facial pain syndromes that are difficult to diagnose and treat. Although many surgical modalities are available, outcomes remain suboptimal. The aim of this study is to present our experience in management of trigeminal neuropathy with a focus on the effectiveness and long-term efficacy of the different surgical procedures. Methods: A single-center retrospective cohort study was conducted from December 2012 until February 2020. Results: Twenty-eight patients (19 females, 9 males) were included in this study. They had 40 surgical interventions. At last follow-up, 1 patient (33.3%) treated by spinal cord stimulation (SCS) had no pain recurrence and 2 patients (66.6%) had their devices removed because of therapeutic failure. Median time to pain recurrence after SCS was 19.5 months (interquartile range [IQR], 29.79 months). Six patients were treated with peripheral nerve stimulation (PNS). At last follow-up, 2 patients had satisfactory pain relief, whereas half of the patients had no improvement. For the 17 patients treated with computed tomography–guided trigeminal tractotomy/nucleotomy, true failure occurred 7 times in 6 patients. Median time to pain recurrence was 5.6 months (IQR, 6.2). Of the 6 patients treated with caudalis DREZ, 3 (50%) had satisfactory pain relief for >1 year and the median time to pain recurrence was 3.9 months (IQR, 29.53). Conclusions: Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. The long-term efficacy of available interventions does not meet patients' satisfaction. More organized prospective studies with longer follow-up are needed to define the patient population best served by each surgical modality.
KW - CT-guided trigeminal tractotomy/nucleotomy
KW - CaudalisDREZ
KW - PNS
KW - SCS
KW - Trigeminal neuropathy
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U2 - 10.1016/j.wneu.2022.10.057
DO - 10.1016/j.wneu.2022.10.057
M3 - Article
C2 - 36273728
AN - SCOPUS:85143591099
SN - 1878-8750
VL - 170
SP - e57-e69
JO - World Neurosurgery
JF - World Neurosurgery
ER -