Patient's assessment of outcome after three surgical procedures for the management of trigeminal neuralgia

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Abstract
Four hundred and seventy five patients with trigeminal neuralgia underwent cryotherapy (145), radiofrequency thermocoagulation (265) or microvascular decompression 65) and were then followed up for mean time of 45 months. Outcome of treatment was assessed not only by the clinicians but also by a postal questionnaire. The presence of anxiety and depression was determined and compared to 51 patients due to undergo surgery. The median time to recurrence for the cryotherapy patients and the radiofrequency thermocoagulation patients were 6 and 24 months, respectively. At 5 years 38% of the microvascular decompression patients had had a recurrence of neuralgia. There was one operative death in the radiofrequency thermocoagulation group. Patients in all three groups were satisfied with their treatment but the questionnaires showed that clinicians under-report the recuccrence of pain and post operative complications. Pre-operatively depression and anxiety are high but post-operatively only 15% were depressed. Patients need careful pre-operative assessment which includes the McGill Pain Questionnaire and they should be given a choice about which surgical method would be most suitable in their case. Printed information should be available to supplement the consultation. This would ensure the patients' expectations matched up with the results as they would be aware of possible outcomes.