Evidence-Based Patient Selection in Headache Surgery: The Impact of Preoperative RFA Treatment on Surgical Outcomes
Maria E. Casari, NA1, Lisa Gfrerer, M.D., Ph.D.2, Christian Chartier, NA1 and William G. Austen Jr, MD3, (1)Massachusetts General Hospital, Boston, MA, (2)Massachusetts General Hospital, Harvard Medical School, Boston, MA, (3)Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Background: Radiofrequency ablation (RFA) is a minimally- invasive treatment option for patients suffering from headache. Nerves ablated with RFA have been shown to develop abnormal histological features, and there is concern that RFA may cause nerve damage. Patients who undergo headache surgery after failed RFA treatment present a unique opportunity to evaluate RFA treated nerves and determine the impact on headache surgery outcomes.
Methods: Of the 158 patients included in this study, thirty-three had a history of RFA treatment. Migraine Headache Index, Pain Self-Efficacy Questionnaire, and Pain Health Questionnaire- 2 outcome scores were recorded preoperatively and at follow- up visits (3 months, 1 year and yearly thereafter). Intraoperative macroscopic nerve damage and surgical outcomes were compared between RFA and non- RFA patients by Chi- square and t- tests.
Results: RFA- treated patients had a higher rate of macroscopic nerve damage (39%) than non RFA- treated patients (17%) (p= 0.005), and were significantly more likely to require a second surgery at the site of primary decompression (27% versus 6%; p= 0.001), as well as nerve transection (12% versus 2%; p= 0.02). Outcome scores at the last follow up visit were comparable between RFA- treated and non RFA- treated patients (p= 0.16).
Conclusion: Although RFA patients can achieve equivalent outcomes to non- RFA patients, a higher number of a secondary surgery at the site of primary decompression and nerve transections are required. RFA- treated patients should be counselled about an increased risk of same-site surgery and nerve transection to achieve acceptable outcomes.
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