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Predictive Model for Pain Recurrence After Posterior Fossa Surgery for Trigeminal Neuralgia
Philip V. Theodosopoulos, MD;
Elysa Marco, MD;
Carol Applebury, RN;
Kathleen R. Lamborn, PhD;
Charles B. Wilson, MD, MSHA
Arch Neurol. 2002;59:1297-1302.
Background Surgical exploration of the posterior fossa is the definitive treatment
for trigeminal neuralgia refractory to medication, but predictors of its success
in effecting long-term pain relief have not been established.
Objective To develop a model that allows stratification of patients' risk of postoperative
recurrence of pain based on pretreatment factors.
Methods We reviewed the records of 420 consecutive patients who underwent posterior
fossa exploration by one of us (C.B.W.) for the treatment of idiopathic trigeminal
neuralgia. The primary outcome measure was recurrence of trigeminal pain.
The predictive value of preoperative and intraoperative factors was evaluated.
Multivariate analysis revealed the statistically significant predictors of
pain recurrence, permitting creation of a risk model for recurrence of pain.
Results After surgery, trigeminal pain had lessened in 98% of patients and completely
resolved in 87%. There were no perioperative deaths. After a mean follow-up
of 56.3 months, 93% of patients reported significant pain improvement and
72% continued to have no pain. The estimated likelihood of pain recurrence
at 8 years was 34%. Significant predictors of eventual recurrence of pain
were age younger than 53 years at the time of surgery, symptoms lasting longer
than 11 years, female sex, and pain on the left side in men. These
factors were weighted and incorporated into a risk model that revealed 4-year
pain-free survival of 89% ± 4% for the low-risk group, 80% ±
4% for the moderate-risk group, and 58% ± 6% for the high-risk group
(data are mean ± SD).
Conclusions We developed a predictive model that stratifies the risk for eventual
recurrence of pain after posterior fossa exploration for trigeminal neuralgia.
This information may be useful in counseling patients regarding treatment.
From the Department of Neurological Surgery, The University of California,
San Francisco, School of Medicine.
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