J Korean Neurosurg Soc.  2021 Sep;64(5):827-836. 10.3340/jkns.2020.0333.

Percutaneous Radiofrequency Thermocoagulation in Trigeminal Neuralgia : Analysis of Early and Late Outcomes of 156 Cases and 209 Interventions

• Gunduz HB
• Cevik OM
• Asilturk M
• Gunes M
• Uysal ML
• Sofuoglu OE
• Emel E

• KMID: 2519710
• DOI: http://doi.org/10.3340/jkns.2020.0333

Abstract

Objective
: Trigeminal neuralgia is one of the most common causes of facial pain. Our aim is to investigate the efficacy and borders of percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.
Methods
: Between May 2007 and April 2017, 156 patients with trigeminal neuralgia were treated with radiofrequency thermocoagulation. These 156 patients underwent 209 procedures. In our study, we investigated the early and late results of percutaneous radiofrequency thermocoagulation under guiding fluoroscopic imaging in the treatment of trigeminal neuralgia. Barrow Neurological Institute (BNI) pain scale was used for grading the early results. In addition, Kaplan-Meier survival analysis was used to assess long-term outcomes. Of the 156 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia, 45 had additional disease. Patients with this condition were evaluated with their comorbidities. Early and late results were compared with those without comorbidity.
Results
: In 193 of 209 interventions BNI pain scale I to III results were obtained. Out of the 193 successful operation 136 patients (65.07%) were discharged as BNI I, 14 (6.70%) as BNI II, 43 (20.58%) as BNI III. Sixteen patients (7.65%) remained uncontrolled (BNI IV and V). While the treatment results of trigeminal neuralgia patients with comorbidity seem more successful in the early period, this difference was not observed in follow-up examinations.
Conclusion
: Finally, we concluded that percutaneous radiofrequency thermocoagulation of the Gasserian ganglion is a safe and effective method in the treatment of trigeminal neuralgia. However, over time, the effectiveness of the treatment decreases. Neverthless, the reapprability of this intervention gives it a distinct advantage.

Keyword

Facial pain; Foramen ovale; Radiofrequency ablation; Trigeminal neuralgia

Figure

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  Fig. 1. Trajectory of the catheter needle in lateral (A) and oblique submental (B) cranial radiograph images.

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  Fig. 2. Early period results according to Barrow Neurological Institute pain intensity scale.

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  Fig. 3. A graph showing Kaplan-Meier analysis of the pain-free survival rate of 209 surgical procedures with trigeminal neuralgia treated by radiofrequency thermocoagulation. X-axis denotes pain-free survival in years and y-axis denotes cumulative survival.

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  Fig. 4. Comparison of the cumulative pain control chances.

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