TY - JOUR
T1 - Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia
AU - Lopez, Benjamin C.
AU - Hamlyn, Peter J.
AU - Zakrzewska, Joanna M.
AU - Burchiel, Kim J.
AU - Sandquist, Michael
AU - Henderson, Jaimie M.
AU - Hodge, Charles J.
AU - Lunsford, L. Dade
PY - 2004/4
Y1 - 2004/4
N2 - OBJECTIVE: There are no randomized controlled trials comparing retrogasserian percutaneous radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression of the gasserian ganglion, and stereotactic radiosurgery, nor are there systematic reviews using predefined quality criteria. The objective of this study was to systematically identify all of the studies reporting outcomes and complications of ablative techniques for treatment of trigeminal neuralgia, from the development of electronic databases, and to evaluate them with predefined quality criteria. METHODS: Inclusion criteria for the outcome analysis included thorough demographic documentation, defined diagnostic and outcome criteria, a minimum of 30 patients treated and median/mean follow-up times of 12 months, not more than 20% of patients lost to follow-up monitoring, Kaplan-Meier actuarial analysis of individual procedures, less than 10% of patients retreated because of failure or early recurrence, and a minimal dose of 70 Gy for stereotactic radiosurgery. High-quality studies with no actuarial analysis were used for the evaluation of complications. RESULTS: Of 175 studies identified, 9 could be used to evaluate rates of complete pain relief on a yearly basis and 22 could be used to evaluate complications. In mixed series, radiofrequency thermocoagulation offered higher rates of complete pain relief, compared with glycerol rhizolysis and stereotactic radiosurgery, although it demonstrated the greatest number of complications. CONCLUSION: Radiofrequency thermocoagulation offers the highest rates of complete pain relief, although further data on balloon microcompression are required. It is essential that uniform outcome measures and actuarial methods be universally adopted for the reporting of surgical results. Randomized controlled trials are required to reliably evaluate new surgical techniques.
AB - OBJECTIVE: There are no randomized controlled trials comparing retrogasserian percutaneous radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression of the gasserian ganglion, and stereotactic radiosurgery, nor are there systematic reviews using predefined quality criteria. The objective of this study was to systematically identify all of the studies reporting outcomes and complications of ablative techniques for treatment of trigeminal neuralgia, from the development of electronic databases, and to evaluate them with predefined quality criteria. METHODS: Inclusion criteria for the outcome analysis included thorough demographic documentation, defined diagnostic and outcome criteria, a minimum of 30 patients treated and median/mean follow-up times of 12 months, not more than 20% of patients lost to follow-up monitoring, Kaplan-Meier actuarial analysis of individual procedures, less than 10% of patients retreated because of failure or early recurrence, and a minimal dose of 70 Gy for stereotactic radiosurgery. High-quality studies with no actuarial analysis were used for the evaluation of complications. RESULTS: Of 175 studies identified, 9 could be used to evaluate rates of complete pain relief on a yearly basis and 22 could be used to evaluate complications. In mixed series, radiofrequency thermocoagulation offered higher rates of complete pain relief, compared with glycerol rhizolysis and stereotactic radiosurgery, although it demonstrated the greatest number of complications. CONCLUSION: Radiofrequency thermocoagulation offers the highest rates of complete pain relief, although further data on balloon microcompression are required. It is essential that uniform outcome measures and actuarial methods be universally adopted for the reporting of surgical results. Randomized controlled trials are required to reliably evaluate new surgical techniques.
KW - Balloon compression
KW - Gamma knife surgery
KW - Glycerol
KW - Radiofrequency
KW - Stereotactic radiosurgery
KW - Thermocoagulation
KW - Trigeminal neuralgia
UR - http://www.scopus.com/inward/record.url?scp=1842535197&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=1842535197&partnerID=8YFLogxK
U2 - 10.1227/01.NEU.0000114867.98896.F0
DO - 10.1227/01.NEU.0000114867.98896.F0
M3 - Review article
C2 - 15046666
AN - SCOPUS:1842535197
SN - 0148-396X
VL - 54
SP - 973
EP - 983
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -