Background & Aims

Trigeminal neuralgia (TN) is a painful condition characterized by paroxysmal, recurrent, electric shock-like pain in the face. Pain episodes can occur spontaneously or be triggered by innocuous activities such as light touch, eating, or talking. TN significantly impairs quality of life and working ability. Primary treatment for TN is pharmacological. Long-term efficacy of medical treatment diminishes over time and it has been evaluated that 33-50% patients need invasive treatment.
Electrocoagulation is established treatment method for drug resistant and chronic idiopathic TN. Aim of this study was to evaluate outcomes and complications after Gaisserian Ganglion electrocoagulation for chronic idiopathic TN.

Methods

Retrospective analysis of 131 patients treated with Gaisserian Ganglion electrocoagulation between 1998 and 2021 at Kuopio University Hospital (KUH). Patient records were collected from the electronic medical records of KUH based on the ICD-10 diagnosis code G50.0 (trigeminal neuralgia) and NOMESCO (Nordic Medico-Statistical Committee) procedure code AAH30 (thermal destruction of cranial nerve). Gender, age, symptom appearance and its laterality, pain medication and etiology were recorded. Treatment outcomes, presence of complications and technical success of operation were collected separately for each procedure.

Results

Out of 131 patients 71 were female (54,2%). Symptoms began at an average age of 56,7 years. Right sided symptoms were more common (56,6% vs 43,5%). Etiology was idiopathic in 61,8% of cases. Seventy-eight percent of patients had an excellent or good response for primary operation. 15 patients (14,2%) had complication, of which one was Anesthesia Dolorosa (0,9%). Second procedure was done for 51 patients. Response was excellent or good for 32 patients (62%). Complications were more common (27,4% vs 14,2%) after second operations. Three patients (5,9%) suffered from anesthesia dolorosa after their second operation. Third operation was done for 24 patients. Eleven patients got excellent or good response (46%) after tertiary procedure, 13 patients (54,2%) got complication and 4 of complications was presence of anesthesia dolorosa (16,7%).

Conclusions

Electrocoagulation is effective and safe procedure for treatment of drug-resistance idiopathic Trigeminal Neuralgia on selective patients. On KUH cohort, the treatment outcomes and complication rates for primary interventions was in line with existing literature. Secondary operations were beneficial for most patients. However, after tertiary procedures more than 50% of patients were non-responders. Number of complications was acceptable after primary and secondary procedures. After third operation more than half of patients suffered from complications. Based on the analysis, repeat procedures should be carefully considered. When decision to reoperate is being made, the above-mentioned benefit-risk-ratios should be discussed with patient.

References

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Presenting Author

Henna-Kaisa Jyrkkänen

Poster Authors

Henna-Kaisa Jyrkkänen

MD, PhD

Kuopio University hospital

Lead Author

E-mail

Sara Matikka Med Student

University of Eastern Finland

Lead Author

E-mail

Katja Luostarinen MD

Kuopio University Hospital

Lead Author

E-mail

Mette Nissen

MD PhD

Kuopio University Hospital

Lead Author

E-mail

Mikael von und zu Fraunberg

MD Professor

Oulu University Hospital

Lead Author

E-mail

Jukka Huttunen

MD Adj Professor

Kuopio University Hospital

Lead Author

E-mail

Topics

  • Treatment/Management: Interventional Therapies – Ablation Techniques

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