A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia

Abstract

Objectives Radiofrequency thermocoagulation (RFT) is a type of Gasserian ganglion-level ablative intervention that is used for the treatment of trigeminal neuralgia. Guidance technologies are used to assist in the cannulation of the foramen ovale (FO) or foramen rotundum (FR) target. We conducted a systematic review to assess the value of different guidance technologies for RFT. Methods We searched PubMed, Embase, the Cochrane database, Web of Science, and PROSPERO for studies published from January 2005 until December 2020. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and the nonrandomized studies of interventions-I tool were used to assess individual study characteristics and overall quality. Results Our query identified 765 publications, and we were able to analyze 11 studies on patients suffering from trigeminal neuralgia. Only one study involved randomized controlled trials, whereas the others featured nonrandomized designs, predominantly before-and-after comparisons. Most of them were observational studies. A total of 222 participants were included, with a median number (range) of 20 (3–53) participants. The objective response rate (ORR) of the one-puncture success rate of RFT using puncture guidance for trigeminal neuralgia was 92% [95% CI (0.79–1), P < 0.001]. Statistically significant differences were observed in the cannulation and operation times between the guided and manual puncture groups (P < 0.001). Conclusions RFT with puncture guidance technology has an absolute advantage in puncturing the foramen ovale or foramen rotundum.

Percutaneous Continuous Radiofrequency Versus Pulsed Radiofrequency Thermorhizotomy for the Treatment of Neuralgia of the Trigeminal Nerve: A Retrospective Observational Study

“…Generally, meta-analyses and systematic reviews converge in suggesting that short-term results exhibit comparability across all three techniques, with prolonged follow-up revealing greater recurrence rates in those exclusive to P-rF. Conversely, instances of hypoesthesia are both less prevalent and of shorter duration in patients subjected to P-rF [ 26 , 27 ]. Some ongoing studies are dedicated to exploring new, safer techniques for addressing the gasser ganglion through the foramen ovale [ 28 ].…”

Effects of the MR-DTI Characteristics of the Trigeminal Ganglion Target on Radiofrequency Treatment in Patients with Trigeminal Neuralgia: A Retrospective Observational Clinical Study

“…Bony landmarks are easy to identify and easily marked on the surface of the face and visualized in X-ray projections. Various techniques and applications, such as 3D-CT skull base reconstruction, stereotactic frames, or navigation, have been implemented to resolve these issues [ 1 , 7 ]. The aforementioned studies suggested that accurate puncture allows for a more efficient operation and a reduced need for repeat punctures.…”

“…The single-puncture rate in radiofrequency treatment has attracted great attention. The PSR procedure has two key steps, including puncture of the FO and TG [ 7 ]. In certain circumstances, the FO is difficult to access in certain circumstances, such as when the trajectory is obstructed by the maxilla or mandible, the distance between the mandible and tooth ridge is too narrow, the FO is covered by the peripheral bones, or the FO is small; in these circumstances, the first puncture attempt is often unsuccessful, and multiple attempts are needed [ 8 , 9 ], potentially causing unnecessary damage and complications.…”

“…Accordingly, it is vitally important that the location of the lesion in the TG be determined by MR-DTI to ensure adequate puncture for PSR [ 15 ]. Consequently, the characteristics of the TGT could serve as a novel indicator of puncture difficulty in PSR, as accurate puncture and treatment are important to ensuring the effects of PSR [ 7 ].…”

Computed tomography-guided Gasserian ganglion interventions for cancer-related facial pain in patients with complex anatomy: Insights and recommendations

“…Two previous meta-analyses [ 19 , 20 ] concluded that puncture guidance technology has an absolute advantage in puncturing the foramen ovale, can improve the one-puncture success rate, learning curve, and safety, and can reduce the incidence of complications and operation times. We reproduced this in an oncological population with complex anatomy using CT guidance.…”