Document Detail


Radiofrequency thermocoagulation for trigeminal neuralgia without intra-operative patient waking.
MedLine Citation:
PMID:  22483199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: It is proposed that radiofrequency thermocoagulation (RFT) under general anaesthesia without waking the patient intra-operatively, which is usually performed to confirm lesion location, will reduce the peri-operative discomfort and anxiety suffered by patients.
METHODS: A retrospective review of all procedures, identified through standard hospital audit codes and performed by a single surgeon from 2000 to 2007. Postal questionnaires were sent to all eligible patients. Outcome criteria included pain relief, adverse events and patients' views on satisfaction, timing and outcomes. A Kaplan-Meier plot was used to determine actuarial rates of pain relief.
RESULTS: Follow-up was available for 84% (37/44) of patients. Complete post-operative pain relief was 96% (42/44). The actuarial rates of complete pain relief at 6, 12, 24 and 36 months were 89%, 79%, 66% and 43%. No patients reported an outcome that did not meet their expectations while 71% (20/28) had an outcome that was better than their expectation. Serious complications included corneal numbness affecting 12% (5/41), but no cases of keratitis and a single case of anaesthesia dolorosa.
CONCLUSIONS: Not waking a patient intra-operatively when performing a RFT is a viable treatment option that results in excellent early pain relief, comparable to results in the literature and without an increase in complications. Patient reported outcomes indicate a high rate of satisfaction and are a novel addition to our understanding of the procedure; there is no comparable data in the literature documenting patient satisfaction outcomes when the procedure is performed with patient waking.
Authors:
Michael G Hart; Mark Nowell; Hugh B Coakham
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Publication Detail:
Type:  Journal Article     Date:  2012-04-07
Journal Detail:
Title:  British journal of neurosurgery     Volume:  26     ISSN:  1360-046X     ISO Abbreviation:  Br J Neurosurg     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-29     Completed Date:  2012-08-22     Revised Date:  2013-01-15    
Medline Journal Info:
Nlm Unique ID:  8800054     Medline TA:  Br J Neurosurg     Country:  England    
Other Details:
Languages:  eng     Pagination:  392-6     Citation Subset:  IM    
Affiliation:
Academic Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital, Cambridge, UK. m.g.hart@doctors.net.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesia, General
Electrocoagulation / methods*
Female
Humans
Intraoperative Care / methods
Male
Middle Aged
Pain Measurement
Pain, Postoperative / prevention & control
Patient Satisfaction
Quality of Life
Questionnaires
Radiosurgery / methods*
Recurrence
Treatment Outcome
Trigeminal Neuralgia / surgery*
Wakefulness
Comments/Corrections
Comment In:
Br J Neurosurg. 2012 Dec;26(6):932; author reply 933   [PMID:  22967114 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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