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Background:
Trigeminal neuralgia (TN) is a pain appearing in the ophthalmic (V1), maxillary (V2), and mandibular (V3) trigeminal branches. Pharmacologic treatment is the first line for TN; however, many patients prefer to receive minimally invasive treatment rather than medicine because of intolerable side effects. Thermocoagulation radiofrequency...
Contexts in source publication
Context 1
... ranging from 7 to 10 indicated the worst possible pain (Tables 1). Facial numbness before and after the operation were scored as: "0" no numbness, "1" mild numbness (tolerable, without significant impact on life or work), "2" moderate numbness (with some impact on life), and "3" severe numbness (intolerable) ( Table 2). ...Context 2
... ranging from 7 to 10 indicated the worst possible pain (Tables 1). Facial numbness before and after the operation were scored as: "0" no numbness, "1" mild numbness (tolerable, without significant impact on life or work), "2" moderate numbness (with some impact on life), and "3" severe numbness (intolerable) ( Table 2). ...Citations
... In their systematic review of the efficacy and safety of percutaneous approaches in the management of TN, Texakalidis et al emphasized that when solely targeting the maxillary division, 31 it was difficult to contain the thermocoagulatory damage from reaching the ophthalmic or mandibular divisions and its real-time detection. [31][32][33] Tang et al in their study, which enrolled older patients above 70 years of age, reported an excellent pain relief in all their patients at discharge, with 49% maintaining pain relief even after 10 years. 34 Zhao et al in their RF series of 1,070 patients reported a pain-free rate in 70.2% of the patients at 10 years and reported that patients prone to long-term pain recurrence are those having initial poor response to medications, patients with atypical facial pain, and patients with previous facial numbness. ...
Background Although medical treatment is the mainstay of therapy, in trigeminal neuralgia (TN), patients failing to respond to it make them candidates to ablative or nonablative procedures.
Objective The aim of this study was to compare the outcome of Microvascular decompression (MVD) and radiofrequency (RF) thermocoagulation in the management of TN affecting the mandibular and maxillary divisions.
Methods Retrospective analysis of the data of 40 patients suffering from intractable classical TN affecting the maxillary or mandibular divisions or both was carried out. Twenty patients were operated upon by MVD of the trigeminal nerve; and 20 had RF ablation of the maxillary or mandibular divisions of the trigeminal nerve or both.
Results In MVD the overall successful outcome was achieved in 16 patients (80%), while the failure was in 4 patients (20%) of which 3 had a fair outcome and 1 patient had a poor outcome. Whereas in RF the overall successful outcome was achieved in 17 patients (85%), while the failure was in 3 patients (15%) of which 2 had a fair outcome and 1 patient had a poor outcome. Outcome was insignificantly different between both groups (p-value 0.806).
Conclusion MVD and RF ablation represent safe and efficacious surgical choices for addressing TN that encompasses both the mandibular and maxillary divisions. Long-term follow-up studies demonstrate that MVD consistently yields favorable outcomes, establishing it as the preferred primary surgical technique, unless contraindicated by the patient's general health and specific needs.
... The objective of improving both clinical outcomes and safety has promoted a shift in the treatment strategy in percutaneous RFTC for TN from intracranial localization to selective extracranial localization of individual divisions [12]. The transfer of interventional targets from the intracranial ganglion to the extracranial trigeminal nerve has been reflected in recent studies that used the extracranial within-FO approach to selectively destroy the MN [13][14][15]. ...
Background
Percutaneous radiofrequency thermocoagulation (RFTC) has been widely utilized in the management of trigeminal neuralgia. Despite using image guidance, accurate needle positioning into the target area still remains a critical element for achieving a successful outcome. This study was performed to precisely clarify the anatomical information required to ensure that the electrode tip is placed on the sensory component of the mandibular nerve (MN) at the foramen ovale (FO) level.
Methods
The study used 50 hemi-half heads from 26 South Korean adult cadavers.
Results
The cross-sectioned anterior and posterior divisions of the MN at the FO level could be distinguished based on an irregular boundary and color difference. The anterior division was clearly brighter than the posterior one. The anterior division of the MN at the FO level was located at the whole anterior (38.0%), anteromedial (6.0%), anterior center (8.0%), and anterolateral (22.0%) parts. The posterior division was often located at the whole posterior or posterolateral parts of the MN at the FO level. The anterior divisions covered the whole MN except for the medial half of the posterolateral part in the overwrapped images of the cross-sectional areas of the MN at the FO level. The cross-sectional areas of the anterior divisions were similar in males and females, whereas those of the posterior divisions were significantly larger in males (P = 0.004).
Conclusions
The obtained anatomical information is expected to help physicians reduce unwanted side effects after percutaneous RFTC within the FO for the MN.
... The objective of improving both clinical outcomes and safety has promoted a shift in the treatment strategy in percutaneous RFTC for TN from intracranial localization to selective extracranial localization of individual divisions [12]. The transfer of interventional targets from the intracranial ganglion to the extracranial trigeminal nerve has been reflected in recent studies that used the extracranial within-FO approach to selectively destroy the MN [13][14][15]. ...
Background: Percutaneous radiofrequency thermocoagulation (RFTC) has been widely utilized in the management of trigeminal neuralgia. Despite using image guidance, accurate needle positioning into the target area still remains a critical element for achieving a successful outcome. This study was performed to precisely clarify the anatomical information required to ensure that the electrode tip is placed on the sensory component of the mandibular nerve (MN) at the foramen ovale (FO) level.
Methods: The study used 50 hemi-half heads from 26 South Korean adult cadavers.
Results: The cross-sectioned anterior and posterior divisions of the MN at the FO level could be distinguished based on an irregular boundary and color difference. The anterior division was clearly brighter than the posterior one. The anterior division of the MN at the FO level was located at the whole anterior (38.0%), anteromedial (6.0%), anterior center (8.0%), and anterolateral (22.0%) parts. The posterior division was often located at the whole posterior or posterolateral parts of the MN at the FO level. The anterior divisions covered the whole MN except for the medial half of the posterolateral part in the overwrapped images of the cross-sectional areas of the MN at the FO level. The cross-sectional areas of the anterior divisions were similar in males and females, whereas those of the posterior divisions were significantly larger in males (P = 0.004).
Conclusions: The obtained anatomical information is expected to help physicians reduce unwanted side effects after percutaneous RFTC within the FO for the MN.
... This procedure is not only a curative therapy but can also be used as a diagnostic measure. 4 This study aimed to demonstrate the potential of radiofrequency ablation in the management of trigeminal neuralgia pain. ...
Introduction: Radiofrequency ablation is the most commonly used percutaneous procedure to treat trigeminal neuralgia. This therapy is less invasive, safe, and provides immediate results and minimal side effects. This study aims to demonstrate the potential of radiofrequency ablation in the management of trigeminal neuralgia pain. Case presentation: A 64-year-old man with recurrent trigeminal neuralgia was treated with radiofrequency ablation at Hasanuddin University Hospital. The patient had previously received radiofrequency ablation at the same site as now, and the patient was pain-free for up to three years. After the procedure, complaints of pain gradually subsided for two months until the patient felt pain-free. Conclusion: Radiofrequency ablation is a minimally invasive alternative treatment for chronic pain that is not controlled by pharmacotherapy, such as trigeminal neuralgia. Good knowledge of anatomy and imaging techniques is required for successful therapy. In this patient, the radiofrequency ablation procedure was quite successful, characterized by complaints of pain which gradually subsided in two months until the patient felt pain-free.
... Hence, various complications related to thermocoagulation could be developed and prevent the widespread use of RFT [26]. An observational study estimated the effectiveness and safety of RFT of the V 1 (10%), V 1 þ V 2 (63.7%, and V 1 þ V 2 þ V 3 (26.3%) of TN. 97.5% patients experienced tolerable numbness, 17.5% patients experienced mildly decreased corneal reflex, 2.5% patients felt a foreign body sensation [27]. As our results showed, there were no surgical puncturerelated complications after RFT procedure. ...
Objective
To estimate long-term efficacy and safety for maxillary trigeminal neuralgia (TN) using radiofrequency thermocoagulation (RFT) targeted on Gasserian ganglion, and to identify the factors which may influence outcomes after procedure.
Methods
From 2006 to 2019, 1070 patients underwent RFT for the treatment of medically refractory maxillary TN was included. All patients were followed up for at least 2 years. Outcomes and complications were recorded and analysed. Logistic regression analysis was employed to identify risk factors of long-term pain recurrence. Prognostic value was calculated from receiver-operating characteristic curve (ROC).
Results
Longitudinal analysis was taken place for 97 non-responders (9.1%) with ineffective pain relief, 253 responders (23.6%) with pain recurrence and 720 responders (67.3%) without pain recurrence. The median pain-free survival (PFS) was 112.0 months (95% CI: 107.5, 116.5). The pain-free rates were 89.9% (95% CI: 88.0–91.8%) at 1 year, 83.8% (95% CI: 81.5–86.1%) at 2 years, 75.4% (95% CI: 72.7–78.1%) at 5 years and 70.2% (95% CI: 67.4–73.0%) at 10 years. Atypical facial pain (HR = 5.373, 95% CI: 2.623–11.004, p < .001), previous facial numbness (HR = 5.224, 95% CI: 3.107–8.784, p < .001) and poor initial response to medication (HR = 3.185, 95% CI: 2.087–4.860, p < .001) were independently associated with long-term pain recurrence. Patients with prognostic index (PI) > 0.25 were identified as high-risk for recurrent TN (HR = 5.575, 95% CI: 3.991–7.788, p < .001). New and worsen facial hypoesthesia was recorded in 77.9% of patients corresponding with BNI score II–IV, and 18.7% reported improved sensation. Severe complication incidence including troublesome dysesthaesia, keratitis and masseter weakness was higher in 80 °C group.
Conclusions
Favourable outcomes were achieved in terms of long-term pain relief and complications rate after RFT for maxillary TN. Patients with typical facial pain, normal facial sensation, and good initial response to medications may have favourable long-term outcomes.
Key messages
This is a retrospective analysis of radiofrequency thermocoagulation (RFT) targeted on Gasserian ganglion for the treatment of maxillary trigeminal neuralgia (TN) during long-term follow-up. Recurrence-free survival among a large sample was assessed and risk factors associated with long-term pain recurrence was identified. It has been verified that inadvertent damage of ophthalmic and mandibular division causes ophthalmic and masticatory complications. Therefore, a more precise needle tip position and thermocoagulation using a relatively low temperature was recommended.
... The recurrence rate following RFT ranged from 0 to 26% (20,25,32,34,39,50,51,59,63,64,67) Table I. Regarding complications, moderate facial hypoesthesia occurred in 7.1-100% of patients who underwent RFT (Table II) (17,(19)(20)(21)(22)(23)(26)(27)(28)(29)(30)(31)34,35,40,41,45,46,52,58,60,61,(63)(64)(65)(66)69), whereas bothersome dysesthesia occurred in 0-36% of patients (12,18,22,26,28,29,31,33,36,37,(40)(41)(42)45,47,48,50,51,(53)(54)(55)(56)59,62,65,68,69) and anesthesia dolorosa was present in 0-9.6% of patients (31,36,37,(47)(48)(49)(50)(51)53,(55)(56)(57)68,69). The percentage ranges of patients identified for the other complications examined were as follows: Masticatory weakness in 0-77.5% (12,17,18,20,21,(26)(27)(28)(29)31,33,34,36,40,42,43,45,(47)(48)(49)(50)(51)(52)(53)(54)(55)59,60,(62)(63)(64)66,68), facial swelling in 0-37.5% (17,18,21,31,33,35,43,(59)(60)(61)64,68), corneal involvement in 0-72.2% ...
... The percentage ranges of patients identified for the other complications examined were as follows: Masticatory weakness in 0-77.5% (12,17,18,20,21,(26)(27)(28)(29)31,33,34,36,40,42,43,45,(47)(48)(49)(50)(51)(52)(53)(54)(55)59,60,(62)(63)(64)66,68), facial swelling in 0-37.5% (17,18,21,31,33,35,43,(59)(60)(61)64,68), corneal involvement in 0-72.2% (17,18,21,23,(26)(27)(28)(29)31,34,36,(40)(41)(42)(43)45,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(60)(61)(62)(63)(64)(65)(66)68), sixth nerve palsy in 0-1.7% (26,28,35,47,49,52,68), otalgia or hypoacousia in 0.21-8.66% (26,36,43,52,62), meningitis in 0.06-3.6% ...
... Among the studies assessed, moderate facial hypoesthesia was the most common complication of RFT, although sensory impairment may be necessary for optimal clinical results (70). Bothersome dysesthesia is also common with RFT but it has rarely been mentioned in the past decade (17,(19)(20)(21)23,27,52,(59)(60)(61)63,64). Anesthesia dolorosa is common following RFT (31,36,53,56,12), although this complication has rarely been mentioned in the past decade. ...
Although microvascular decompression (MVD) should be considered as the first-line treatment for classic trigeminal neuralgia (TN) owing to neurovascular compression of the trigeminal nerve, an increasing number of surgeons prefer radiofrequency thermocoagulation (RFT). RFT is a Gasserian ganglion-level ablative intervention that may achieve immediate pain relief for TN. It is used for emergency management when MVD is not suitable for the patient. As the gold surgical standard of classic trigeminal neuralgia, MVD has the advantage of longer efficacy. However, there are currently no high-quality controlled trials to evaluate the efficacy of MVD and RFT. For the present systematic review, the PubMed, Embase and Cochrane databases (all entries up until July 31, 2020) were searched to identify studies related to RFT in order to provide valuable information for clinical decision-making. The efficacy of the RFT method was evaluated in terms of the initial pain relief percentage, recurrence rate and follow-up time. Furthermore, the incidence rate of various postoperative complications was retrieved. RFT was used for a wider range of applications than MVD, including use for primary (owing to neurovascular compression of the trigeminal nerve), idiopathic and secondary (due to primary neurological diseases) TN, and provided a high rate of initial pain relief and long-term pain control. Although this method has several side effects, the incidence of complications could be reduced by precise cannulation. Furthermore, the complications that occurred were not permanent. Thus, RFT is a safe and effective minimally invasive method of pain relief for patients with TN.
... Because of their invasiveness in brain, motor cortex stimulation and deep brain stimulation are the last resort therapies for postherpetic ophthalmic neuralgia. ermal radiofrequency has been used for treating trigeminal neuralgia for decades and the ophthalmic branch was not a contraindication [27]. Previously, physicians have applied radiofrequency coagulation to the affected nerve branch; however, the pain symptoms disappeared only temporarily and were replaced with new forms of pain, similar to insect bites or ants crawling on the skin [6]. ...
Postherpetic neuralgia (PHN) is a painful, long-lasting condition as a consequence of nerve damage resulting from a herpes zoster infection. Although there are many different treatments available to reduce pain duration and severity, PHN is often refractory to them and no single therapy shows an effective cure for all cases of PHN, especially for those involving the ophthalmic branch of the trigeminal nerve. Pulsed radiofrequency (PRF) is a minimally invasive procedure for pain treatment that has been practiced over the past decade. However, its clinical efficacy and safety for treating PHN involving the ophthalmic branch of the trigeminal nerve have not been evaluated. Objective. This study aimed to evaluate the efficacy and safety of PRF for treating PHN involving the ophthalmic branch of the trigeminal ganglion. Study Design. An observational study. Setting. All patients received PRF of the ophthalmic branch of the trigeminal nerve, pain intensity was assessed by a visual analogue scale (VAS), and complications before and after PRF stimulation were noted. Methods. Thirty-two patients with PHN of the ophthalmic branch were treated by PRF of the ophthalmic branch with controlled temperature at 42°C for 8 min. Pain relief, corneal reflex, sleep quality, and satisfaction were assessed for all patients. Results. Thirty out of 32 patients (93.75%) reported significant pain reduction after PRF treatment. Twenty-eight of them (87.5%) were satisfied with their sleep and obtained a pain score lower than 3 following the procedure. Only two patients had a recurrence of the severe burning pain and returned to the hospital for other medical therapies 2 weeks after the PRF procedure. No patient lost the corneal reflex. Limitations. This study is an observational study and a nonprospective trial with a short-term follow-up period. Conclusion. PRF of the trigeminal ganglion of the ophthalmic branch can significantly reduce pain sensation and improve sleep quality and satisfaction.
1. Introduction
People infected with the varicella-zoster virus are at risk of developing herpes zoster. Although most cases resolve spontaneously, the pain associated with herpes zoster does not resolve in a substantial number of patients, resulting in a chronic pain condition called postherpetic neuralgia (PHN). PHN is the most common complication of zoster infection and remains a challenging condition to treat. It has been reported that an estimated 12.5% of patients with zoster infection aged ≥50 years develop PHN three months after zoster infection onset and the proportion affected increases sharply with age [1]. Among adults, herpes zoster infects the trigeminal nerve in 15–20% of the cases, with the ophthalmic division being most affected [2]. Following herpes zoster infection of the ophthalmic branch, ocular complications associated with poor visual outcomes include acute corneal lesions, retinitis, optic neuritis, and uveitis. Besides these ocular complications, patients may also develop PHN [3]. Of the symptoms, ophthalmic PHN is the most painful symptom and is characterized by severe burning and lancinating pain often associated with allodynia.
Medication, nerve blocks, and chemical neurolytic blocks have been used to treat PHN of the ophthalmic branch. Unfortunately, the effects are limited and often produce intolerable side effects. In recent years, spinal cord stimulation has been found to be a useful technique for the treatment of intractable chronic neuropathic pain [4]; however, the neuralgia from the ophthalmic branch could hardly be controlled by stimulation in the spinal cord [5, 6]. Peripheral nerve stimulation could also be used to treat herpetic neuralgia and especially more effectively in acute and subacute phases [7, 8]. Pulsed radiofrequency (PRF) is a method that has been used in chronic pain therapy for several decades and has been developed widely in clinical practice [9]. For this therapy, a radiofrequency current is generated intermittently, and heat is washed out during a silent period, which causes minor tissue injury surrounding the needle puncture and prevents nerve degeneration [10]. We herein summarize the efficacy of PRF in the ophthalmic branch to treat intractable PHN, suggesting that PRF is a possible treatment for ophthalmic branch neuralgia.
2. Materials and Methods
2.1. Methods
2.1.1. Patients
Forty-eight patients with PHN of the ophthalmic branch were recruited between August 2014 and February 2017 from the Department of Pain Management, the Second Affiliated Hospital of Guangzhou Medical University. Inclusion criteria were diagnosis of classic PHN of the ophthalmic branch. Patients experienced lancinating or burning pain, paresthesia, or pruritus for over three months. All patients reported moderate to most intense pain (>5) on a visual analogue score (VAS), ranging from 0 (no pain) to 10 (the most intense pain). Ten patients had facial numbness, decreased corneal reflex, or visual impairment on the symptomatic side. Anticonvulsants such as pregabalin 75 mg q12 h were used to treat lancinating pain, while tramadol 100 mg q12 h and a tricyclic antidepressant drug amitriptyline 12.5 mg qn were prescribed for easing burning pain. Patients were excluded from the study if they fulfilled one of the following criteria: noncompliance with physician’s advice, infection on the skin or the deep tissue at the puncture site, the presence of bleeding tendencies, or receiving anticoagulant therapy which could not be replaced with intravenous low-molecular-weight heparin subcutaneous injection. In addition, patients with unstable, severe cardiovascular or cerebrovascular disease, such as trigeminal neuralgia secondary to cranial tumors, were also excluded. Sixteen patients were excluded based on these criteria. This study was approved by the Institute Review Board of the Second Affiliated Hospital of Guangzhou Medical University. Informed consent for participation in this study was obtained from the patients before the treatment.
2.1.2. Surgical Procedure
Our technique was carried out as previously described [10]. The patient was placed in a supine position with the head extended on the Digital Subtraction Angiography (DSA) bed. Standard American Society of Anesthesiology monitors were utilized throughout the procedure. Each patient was premedicated with an intravenous (i.v.) injection of 0.5 mg atropine to maintain the heart rate over 90 and sufentanil 0.08 μg/kg i.v was administered by bolus. Following sterile prep and drape, the C-arm was positioned 15–25 degrees ipsilaterally and 30–35 degrees caudally to show the foramen ovale, located at the upper third of the mandibular ramus, inside of the condyle (Figure 1). A 3 ml of 1% lidocaine was infiltrated in the subcutaneous tissues and a 10 cm long radiofrequency needle with a diameter of 0.7 mm and a 2 mm active tip was directed toward the foramen ovale. The needle trajectory was adjusted fluoroscopically until the radiofrequency trocar resided in proximity to the foramen ovale. A bolus of 1 mg/kg propofol was administered intravenously before the trocar penetrated the foramen ovale to avoid the penetrating pain to the trigeminal ganglion. The final location of the final needle tip was positioned over the slope line 3 mm, as shown in Figure 2; then, the patient was awakened to give the sensorial and motor stimulation. A tissue impedance was controlled around 200–300 Ώ. Motor stimulation 2 Hz with 1.5 mV was performed to exclude motor twitch. Sensorial stimulation 50 Hz with 0.1–0.3 mV was performed to induce paresthesia in the area of the ophthalmic division. After sensorial and motor stimulation, pulsed RF (PRF) was administered with a radiofrequency generator (COSMAN Radiofrequency Therapy Apparatus, USA) at a pulse width of 20 ms and a controlled temperature of 42°C for 8 minutes. We selected a temperature around 42°C to avoid damage to neural structures and tested the corneal reflex, pain sensation, and numbness after PRF. No patients had a loss of the corneal reflex. No additional anesthetics were administered during the PRF treatment. After PRF treatment, the patients continued to use the following medications in the follow-up period: gabapentin 0.1, tid; amitriptyline 12.5 mg, qn; tramadol 50 mg, q12 h.
... Among these procedures, percutaneous radiofrequency thermocoagulation (RFT) has been proved to be an effective treatment for ITN [5,6]. However, some complications, such as facial numbness, decreased corneal reflex, and masseter weakness, have also been reported in patients undergoing RFT [7]. RFT produces heat, leading to denaturation and necrosis of the targeted nerve fibers. ...
Objective
We aimed to evaluate masticatory dysfunction after two different types of ablation on the Gasserian ganglion for the treatment of idiopathic trigeminal neuralgia. We hypothesized that low-temperature plasma radiofrequency ablation (LTP-RFA) was noninferior to radiofrequency thermocoagulation (RFT) with respect to initial efficacy.
Methods
In the randomized, single-blind, parallel-group, noninferiority trial, 204 participants with idiopathic trigeminal neuralgia were randomly allocated to receive plasma ablation in the LTP-RFA group and radiofrequency ablation in the RFT group in a 1:1 ratio, with random block sizes of four or six. Participants were examined at baseline (T0), on the day of discharge (T1), and at the 6-month follow-up (T2). The primary end point was the clinincal effective rate in the LTP-RFA group compared with that in the RFT group after intervention on the day of discharge. Noninferiority was prespecified at -10%.
Results
The intention-to-treat analysis revealed that the initial efficacy rates were 91.2% in LTP-RFA group and 93.1% in RFT group (rate ratio [RR] = 0.979, 95% confidence interval [CI]: 0.904–1.061, P = 0.795). The difference between the two groups was 1.9% (95% CI: -5.6% to 9.4%), which showed that LTP-RFA demonstrated noninferiority compared with RFT in initial efficacy. Compared with the RFT group, the LTP-RFA group exhibited a significantly greater improvement in the maximum voltage of the masseter muscles with mean differences of 11.40 (95% CI: 10.52 to 12.27, P < 0.001) at T1 and 17.41 (95% CI: 14.68 to 20.13, P < 0.001) at T2, respectively. Similar results were observed for the asymmetry index of occlusion, the maximum voltage of the anterior temporalis, and the activity index of anterior temporalis / masseter muscles. No serious adverse events were observed in either group.
Conclusions
Compared with the RFT group, noninferior efficacy for pain relief and improvement of masticatory function was revealed in the LTP-RFA group.
... In our study, we found that combination of pulsed radiofrequency (PRF) followed by thermal radiofrequency has more efficacy and prolonged duration than PRF alone as decrease in VAS from basal (8.65 ± 0.59) to (0.9 ± 0.67) at 24 months and this in agreement with Huang et al. who found that thermocoagulation radiofrequency (TRF) is reported to give higher rates of complete pain relief than either stereotactic radiosurgery or glycerol rhizolysis in treatment of idiopathic TN. The procedure success rate of TRF approaches 100%, being superior to that of microvascular decompression (MVD), which is only 85% [21]. Recently, PRF is becoming an alternative and effective therapy for patients with TN, as it is safe in reputation. ...
Background
Trigeminal neuralgia (TN) is a painful condition characterized by sudden onset, severe unilateral, brief, stabbing recurrent episodes electric shock like pain in the distribution of one or more branches of the trigeminal nerve. Many approaches were used for treatment of TN as balloon decompression, thermocoagulation radiofrequency (TRF), and pulsed radiofrequency (PRF).
Objectives
This study evaluated the effectiveness of combined PRF and TRF for long-term therapy of patients with idiopathic TN.
Patient and methods
Our prospective study was carried out after the approval of ethical committee of Zagazig University Hospital Pain Management Unit from June 2017 to May2019. Overall, 20 adult patients suffering from idiopathic TN who treated with combining PRF and TRF for the gasserian ganglion. PRF (continuous for 20 min, at 42°C) followed by TRF (for 60 s at 70°C, then for 60 s, at 75°C) was performed to the gasserian ganglion. The post-operative pain relief and complications were evaluated at first day, 1, 3, 6, 12, 18, and 24 months after treatment.
Results
There were significant improvements of pain relief as regards Visual Analog Scale showed baseline VAS [8.65 ± 0.59] and first day, 1, 3, 6, 12, 18, 24 months [3.60 ± 1.09, 2.55 ± 0.69, 1.7 ± 0.65, 1.05 ± 0.68, 0.85 ± 0.67, 0.80 ± 0.69, 0.9 ± 0.69], respectively, facial numbness and postoperative masseter muscle weakness recovered more rapidly in patients receiving combined PRF and TRF therapy.
Conclusion
Combination of PRF followed by TRF is effective in treating TN pain with minimal postoperative complications.
... Several studies have observed the specific temperature delivered to the V1 division. e incidence of decreased corneal reflex has been found to be 3.57%-17.5% at temperatures of 62-68°C [34,38]. However, there are no reports of the disappearance of corneal reflexes. ...
... Decreased corneal reflexes were observed in a greater proportion of individuals, at 15.69%-26.47% [20,34,38]. Moreover, ptosis, limited eye movement, diplopia, and corneal ulceration have been reported in the literature with temperatures of 70-90°C [9,21,23,44]. ...
Trigeminal neuralgia (TN) is a common neuropathic pain that seriously affects the daily life of patients. Many invasive treatments are currently available for patients who respond poorly to oral carbamazepine or oxcarbazepine. Among them, radiofrequency (RF) treatment is a viable option with reliable initial and long-term clinical efficacy. The long-term analgesic effects of radiofrequency thermocoagulation (RFT) at high temperatures (≥80°C) are not superior to those at relatively low temperatures (60–75°C). In contrast, the higher the temperature, the greater the risk of complications, especially facial numbness, masticatory muscles weakness, and corneal hypoesthesia. Some patients even experience irreversible lethal complications. Therefore, we recommend low-temperature RFT (60–75°C) for treatment of TN. The therapeutic effects of pulsed radiofrequency (PRF) are controversial, whereas PRF (≤75°C) combined with RFT can improve long-term effects and decrease the incidence of complications. However, large-scale clinical trials are needed to verify the efficacy of the combination of PRF and RFT.
