Introduction: Nearly half of patients with trigeminal neuralgia (TN) fail conservative management and seek surgical management with either rhizotomy or microvascular decompression (MVD). Recent evidence suggests duration of preoperative medical management impacts postoperative outcomes for MVDs, but this has not been investigated for rhizotomies. This study aimed to explore the relationship between preoperative medical management and postoperative outcomes in patients undergoing rhizotomy.
Methods: In this single-center, retrospective cohort study, we recorded clinical and demographic data for patients with TN who underwent first-time rhizotomies at our institution from 1995-2023. Univariate logistic regressions and Cox regression analyses were used to evaluate if number of preoperative pain medications and duration of use were associated with postoperative outcomes, including pain improvement, medication-free remission, and time to pain recurrence.
Results: 504 patients met inclusion criteria. The mean age was 63.2±15.5 years, with 62.2% female patients. The average duration of symptoms prior to neurosurgical consultation was 62.5±76.6 months and the average time on preoperative pain medications was 60.2±74.9 months. At their presentation, 86.2% of patients were taking ≥1 pain medication(s), with 79.1% receiving anticonvulsants and 11.5% receiving opioids. Postoperatively, 75.2% experienced pain improvement and 13.9% achieved remission. The median [95%CI] time to pain recurrence was 8.7[6.7-10.8] months for the entire cohort, 12.8[9.8-15.7] months for patients who had postoperative improvement in pain, and 28.8[0.9-56.7] months for patients who achieved a BNI less than 3 postoperatively. There were no significant associations between time on preoperative pain medications, number of pain medications tried, number of pain medications at presentation to neurosurgery, and postoperative outcomes.
Conclusion : Duration and extent of preoperative medical management were not significantly associated with postoperative outcomes in patients undergoing index rhizotomy for TN. While early neurosurgical referral is valuable for discussing treatment options, our findings suggest prolonged medication use does not diminish the effectiveness of rhizotomies in relieving symptoms.
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