RF Ablation (Rhizotomy) and Anesthesia Dolorosa

One of our members asked me a few days ago about statistics for a severe side effect of Rhizotomy surgery: Anesthesia Dolorosa. I have mis-placed my note on where the question came up. We get a LOT of traffic through here. However, I will post the following abstracts from Pub Med, for all who share an interest in this question... The answer to the question seems to be that AD is not a common side effect of Rhizotomy.

Regards, All -- Red

Acta Neurochir (Wien). 2012 Mar 6. [Epub ahead of print]

Management of bilateral trigeminal neuralgia with trigeminal radiofrequency rhizotomy: a treatment strategy for the life-long disease.

Bozkurt M, Al-Beyati ES, Ozdemir M, Kahilogullari G, Elhan AH, Savas A, Kanpolat Y.


Department of Neurosurgery, Ankara University, Faculty of Medicine, Ankara, Turkey.



The objective of this study was to evaluate the effectiveness of percutaneous controlled radiofrequency trigeminal rhizotomy(RF-TR) in patients with bilateral trigeminal neuralgia (BTN). Patients were analyzed after RF-TR in terms of outcome, safety and complications.


Eighty-nine BTN patients underwent 186 RF-TR procedures. Eighty-seven patients had idiopathic trigeminal neuralgia (ITN) and two patients had multiple sclerosis (2.2%). Fifty-six (62.9%) were women and 33 (37.1%) were men. Ages ranged from 29 to 85 years. Anesthesiawas administered at a determined optimal level, allowing patient cooperation for controlled and selective lesioning.


The mean follow-up period was 101.71 ± 77.7 months. Familial occurrence was seen in two (2.2%) patients. Synchronized pain was observed in 25 (28.2%) patients. Pain occurrence on the contralateral side was observed with an average duration of 124.7 ± 87.13 months. Fifty-four of the 89 patients underwent 146 RF-TR procedures for both sides and 35 underwent 40 RF-TR procedures for one side. Complete pain relief or partial satisfactory pain relief was achieved on the medically treated side in 35 patients. During follow-up, 36 patients required the second procedure and 7 required the third procedure. Acute pain relief was reported in 86 (96.6%) patients. Early (<6 months) pain recurrence was observed in 11 (12.3%) and late (>6 months) recurrence in 25 (28.0%) patients. Complications included diminished corneal reflex in four (2.1%) patients, keratitis in two (1.1%), masseter dysfunction in four (2.1%), dysesthesia in two (1.1%), and anesthesia dolorosain one (0.5%).


RF-TR is an effective, selective, well-controlled, and effortlessly repeatable procedure for treating BTN, especially in the elderly, in terms of low morbidity and mortality rates and high rate of satisfactory pain relief.

[PubMed - as supplied by publisher]
Turk Neurosurg. 2011 Jan;21(1):48-52.
The following abstract has a link to a full text of the article:

Long-term outcomes of percutaneous retrogasserian glycerol rhizotomy in 3370 patients with trigeminal neuralgia.


Research Institute of Surgery & Daping Hospital, Third Military Medical University, Department of Neurosurgery, Chongqing, China. ■■■■■■■■■■■■■■■■■■



To assess the long-term outcomes of percutaneous retrogasserian glycerol rhizotomy(PRGR) in patients with medically unresponsive idiopathic trigeminal neuralgia. MATERIAL and


A total of 3370 patients undergoing PRGR between 1983 and 2003 in our hospital were followed up for 13.1 years (range 3-23 years), and the outcomes were investigated.


Of the 3370 patients, 99.58% had complete initial pain relief. A total of 2750 patients were followed up when 112 died of unrelated causes and 508 were lost to follow up. Of the 2750 patients, 962 (35%) had pain recurrence at various intervals: 0.3% in 1 year; 21% in 1 to 5 years; 7% in 5 to 10 years; 4% in 10 to 15 years and 3% in 15 to 23 years. The major complication was facial numbness, among which hypesthesia outweighed hypalgesia. Most patients recovered within half a year, although 109 patients (3.96%) developed permanent mild hypesthesia. There was no anesthesia dolorosaor surgery related mortality in this series.


PRGR is a minimally invasive and simple procedure yielding a favorable outcome for trigeminal neuralgia. The major complications of this procedure are reversible within various time intervals. It may serve as a first-line surgical modality for patients unresponsive to pharmacotherapy.

[PubMed - indexed for MEDLINE]
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