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.

Source

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

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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%).

CONCLUSIONS:

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.

PMID:
22392016
[PubMed - as supplied by publisher]
Turk Neurosurg. 2011 Jan;21(1):48-52.
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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.

Source

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

Abstract

AIM:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

PMID:
21294091
[PubMed - indexed for MEDLINE]
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