Abstract
Current surgical treatments for refractory trigeminal neuralgia (TN) include microvascular
decompression (MVD), percutaneous rhizotomy, and stereotactic radiosurgery (SRS).
We aimed to map the trends of utilization of these procedures in the USA and examine
factors associated with morbidities and discharge outcome. We performed a retrospective
cohort study with time trends of patients admitted to US hospitals for TN between
1988 and 2008 who received MVD, percutaneous rhizotomy, or SRS as reported in the
Nationwide Inpatient Sample. Univariate and multivariate analyses were conducted to
examine patient demographics, hospital characteristics, and other hospitalization
factors affecting complications and discharges. The use of MVD increased significantly
by 194% from 1988 to 2008 while rhizotomy decreased by 92%. The use of radiosurgery,
introduced in the early 1990s, peaked in 2004 and has declined since. Univariate analysis
revealed patient age, length of hospitalization, hospital teaching status, and hospital
patient volume to be associated with discharge and complications. Multivariate analysis
showed that for MVD, younger age and high hospital volume were predictive of a good
discharge outcome. For rhizotomy, age, median income, urban location, and hospital
volumes were associated with discharge outcome, but only teaching status, urban location,
and hospital volume were associated with complications. For SRS, patient age and length
of stay were found to be important by multivariate analysis on discharge. Mortality
rates for MVD (0.22%), rhizotomy (0.42%), and SRS (0.12%) were low. The clinical practices
for surgical treatment of TN have evolved over time with the rise of MVD and dwindling
of rhizotomy procedures.
Keywords
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Article info
Publication history
Accepted:
December 17,
2012
Received:
October 9,
2012
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
