Practice patterns of in-hospital surgical treatment of trigeminal neuralgia from 1988 to 2010

Abstract

Objective: Neurosurgeons have a variety of procedures to offer when treating medically intractable trigeminal neuralgia (TN). We reviewed the national trends in procedural volume for in-hospital treatment of TN.

Methods: The Nationwide Inpatient Sample (1988-2010) provided data on patients hospitalized with a principal diagnosis of TN and a related principal procedure. We categorized principal procedures as open, other, percutaneous, or radiosurgery.

Results: We identified 13,466 relevant hospital admissions. The volume for open procedures and radiosurgery remained relatively constant, whereas percutaneous procedures decreased. Mean age of patients undergoing percutaneous and radiosurgery procedures (67.9 and 69.5 years) was higher than open and other procedures (60.4 and 63.4 years) (p-value <0.001). The mean total in-hospital inflation-adjusted charges for all four categories increased over time (p-values <0.001). The mean total in-hospital inflation-adjusted charge for radiosurgery ($37,666) was higher than open ($28,046) procedures (p-value <0.001).

Conclusions: Patients who undergo an open procedure to treat TN are younger than those who undergo a percutaneous or a radiosurgery procedure. The perceived risk of open surgery in older patients may drive offering percutaneous or radiosurgical procedures. In addition, the in-hospital inflation-adjusted charges for all procedures increased over time, with radiosurgery being higher than those of open procedures.

Keywords: Nationwide Inpatient Sample; Percutaneous; Radiosurgery; Tic douloureux.