Trigeminal Neuralgia Linked to Multiple Sclerosis: Comparing Surgical Interventions

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Overall costs were similar for radiofrequency rhizotomy and stereotactic radio surgery.
Overall costs were similar for radiofrequency rhizotomy and stereotactic radio surgery.

In a study published in Clinical Neurology and Neurosurgery, radiofrequency rhizotomy and the more expensive stereotactic radio surgery provided immediate pain relief from trigeminal neuralgia associated with multiple sclerosis, but more procedures were required after radiofrequency rhizotomy, resulting in equivalent total costs.

In a single-institute retrospective chart review, the outcomes of patients with trigeminal neuralgia and multiple sclerosis were compared for participants who underwent stereotactic radio surgery (n=7; median age, 58.5 years) or radiofrequency rhizotomy (n=10; median age, 63.5 years) as their first procedures. The researchers measured disability scores, facial pain, medication use, facial numbness, need for subsequent procedures, duration of follow-up, and costs of the first procedure and of subsequent procedures.

After the initial procedure, 71% and 70% of patients who received stereotactic radio surgery and radiofrequency rhizotomy, respectively, had satisfactory pain relief. After a median follow-up of 66.0±58.8 months for the stereotactic radio surgery group and 10.4±43.1 months for the radiofrequency rhizotomy group, 29% of stereotactic radio surgery and 60% of radiofrequency rhizotomy required additional procedures to achieve adequate pain relief. Moreover, compared with patients who underwent radiofrequency rhizotomy, those who underwent stereotactic radio surgery required fewer additional procedures (mean, 2 vs 2.7, respectively).

Although stereotactic radio surgery costs more for the initial procedure ($53,300 vs $12,315), the average subsequent costs were higher for radiofrequency rhizotomy ($8320 vs $36,002), making the total overall costs similar ($61,620 vs $48,317).

In an interview with Clinical Pain Advisor, lead author Marshall Holland, MD, from the Department of Neurosurgery at the University of Iowa Carver College of Medicine, concluded that for radiofrequency rhizotomy, "more treatments will be needed over the same time period as compared to those who choose to undergo stereotactic radiosurgery. Furthermore, despite the initial significant difference in cost of a rhizotomy versus a radiosurgery procedure, the overall cost of treatment of this disease once you consider the necessary subsequent interventions is not different."

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Reference

Holland MT, Teferi N, Noeller J, Swenson A, Smith M, Buatti J, Hitchon PW. Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: a single institution experience. Clin Neurol Neurosurg. 2017;162:80-84.

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