1080 Repeat Percutaneous Rhizotomy for Trigeminal Neuralgia is Not Associated with an Increased Risk of Postoperative Complications

INTRODUCTION: Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. METHODS: We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011-2022. Patients were included if they had no history of prior microvascular decompression (MVD) or radiosurgery or did not undergo concurrent MVD. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergo a repeat rhizotomy. Subgroup analyses were performed by number of rhizotomy, procedure performed, and indication. Potential drivers of postoperative complications were included in a multivariate logistic regression model. RESULTS: Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14. CONCLUSIONS: Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.