Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia

Benjamin C. Lopez, Peter J. Hamlyn, Joanna M. Zakrzewska, Kim J. Burchiel, Michael Sandquist, Jaimie M. Henderson, Charles J. Hodge, L. Dade Lunsford

Research output: Contribution to journalReview article

225 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)973-983
Number of pages11
JournalNeurosurgery
Volume54
Issue number4
DOIs
StatePublished - Apr 2004

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Keywords

  • Balloon compression
  • Gamma knife surgery
  • Glycerol
  • Radiofrequency
  • Stereotactic radiosurgery
  • Thermocoagulation
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Lopez, B. C., Hamlyn, P. J., Zakrzewska, J. M., Burchiel, K. J., Sandquist, M., Henderson, J. M., Hodge, C. J., & Lunsford, L. D. (2004). Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia. Neurosurgery, 54(4), 973-983. https://doi.org/10.1227/01.NEU.0000114867.98896.F0