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A nationwide study of three invasive treatments for trigeminal neuralgia

Koopman, Joseph S.H.A.a,e,*; de Vries, Laura M.b,c; Dieleman, Jeanne P.a; Huygen, Frank J.d; Stricker, Bruno H.Ch.a,b,c; Sturkenboom, Miriam C.J.M.a,b

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doi: 10.1016/j.pain.2010.10.049
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Invasive procedures for treatment of trigeminal neuralgia (TGN) include percutaneous radiofrequency thermocoagulation (PRT), partial sensory rhizotomy (PSR), and microvascular decompression (MVD). Using a nationwide discharge registry from The Netherlands, we assessed the frequency of use and patient characteristics, and evaluated treatment failure for each patient undergoing PRT, PSR, or MVD from January 2002 through December 2004. Only patients without a procedure in the year prior were included. Primary outcome was readmission for repeat procedures for TGN or known complications within 1 year. Comparability of patient populations was assessed through propensity scores based on hospital, age, sex, and comorbidity. Conditional logistic regression matched on propensity score was used to calculate relative risks (RR) with 95% confidence intervals (CIs) for repeat procedures or complications. During the study period, 672 patients with TGN underwent PRT, 39 underwent PSR, and 87 underwent MVD. Hospital type was the predominant determinant of procedure type; age, sex, and comorbidity were weak predictors. The RR for repeat procedures for PSR was 0.21 (95% CI: 0.07 to 0.65) and for MVD was 0.13 (95% CI: 0.05 to 0.35) compared with PRT (RR 1). For complications, the RR of PSR was 5.36 (95% CI: 1.46 to 19.64) and of MVD was 4.40 (95% CI: 1.44 to 13.42). Sex, urbanization, and comorbidity did not influence prognosis, but hospital and surgical volume did. In conclusion, although PSR and MVD are associated with a lower risk of repeat procedure than PRT, they seem to be more prone to complications requiring hospital readmission.

Microvascular decompression and partial sensory rhizotomy are associated with a lower risk of undergoing a repeat procedure compared with percutaneous radiofrequency thermocoagulation but are more prone to complications requiring readmission to hospital.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

aDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands

bDepartment of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands

cDepartment of Pharmaceutical Affairs and Medical Technology, Health Care Inspectorate, The Hague, The Netherlands

dDepartment of Pain Treatment, Erasmus University Medical Center, Rotterdam, The Netherlands

eDepartment of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands

*Corresponding author. Address: Department of Medical Informatics, Room EE 21.55, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. Tel.: +31 10 7044133; fax: +31 10 7044722.

E-mail: skoop29@gmail.com

Submitted December 23, 2009; revised October 21, 2010; accepted October 29, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.
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