Factors Associated With Long‐Term Risk of Recurrence After Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion for Patients With Trigeminal Neuralgia Involving the Ophthalmic Division: A Retrospective Study

Abstract

ObjectiveTo evaluate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of the gasserian ganglion among patients with ophthalmic trigeminal neuralgia (TN) and prognostic factors in terms of recurrence‐free survival (RFS) during a long‐term follow‐up.MethodsFrom January 2005 to December 2017, 300 patients with ophthalmic TN underwent RFT. A retrospective analysis of 14‐year outcomes was performed. Kaplan‐Meier analysis was used for RFS after the procedure. Univariate and multivariate Cox regression analyses were performed to identify risk factors for pain recurrence.ResultsThe initial effective rate of RFT for ophthalmic TN was 92%. The mean follow‐up time was 77.38 ± 43.24 months. The cumulative probability of RFS was 86.94% at 1 year, 80.03% at 2 years, 77.27% at 3 years, 74.01% at 5 years, and 59.92% at 10 years after RFT. The mean duration of RFS was 114.67 months (95% confidence interval [CI] 106.27 to 123.06 months). In multivariate analysis, atypical pain (hazard ratio [HR] = 2.831, 95% CI 1.759 to 4.554, P < 0.001) and mild facial hypesthesia (HR = 2.540, 95% CI 1.309 to 4.931, P = 0.006) before RFT were independently associated with pain recurrence. Patients with a prognostic index (PI) > 1.27 were at high risk for pain recurrence. Major complications included troublesome dysesthesia (0.7%), keratitis (10.9%), diplopia (0.4%), facial paresthesia (6.2%), and masseter weakness (12.7%). Masseter weakness was more common in patients with V3 branch involvement. Three patients lost their sight due to keratitis.ConclusionOur study investigated long‐term outcomes and complications of RFT for ophthalmic TN. Patients at high risk for pain recurrence were identified, which might provide a basis for clinical decision making before RFT.

Long‐term recurrence‐free survival and complications of percutaneous balloon compression and radiofrequency thermocoagulation of Gasserian ganglion for trigeminal neuralgia: A retrospective study of 1313 cases

“…Our data also supported that high temperatures were not superior to those relatively low temperatures ranging from 60 to 75°C in order to gain a long‐term analgesic effect 18 . Although it was challenging to treat TN involving the ophthalmic division, which conducted corneal sensation and can be excessively injured by high temperature, satisfactory immediate and long‐time pain relief were observed in our study by thermocoagulation at 62°C, which was supported by a long‐term follow‐up retrospective research with a large sample 7 …”

“…18 Although it was challenging to treat TN involving the ophthalmic division, which conducted corneal sensation and can be excessively injured by high temperature, satisfactory immediate and long-time pain relief were observed in our study by thermocoagulation at 62°C, which was supported by a long-term follow-up retrospective research with a large sample. 7 Facial numbness appeared to be the most common postoperative complication of PBC, affecting 80.4% of patients with excellent initial pain relief in the present study. Several studies have explored that facial numbness occurred in 90%-96.4% of patients.…”

“…The crude annual incidence is 12.6–28.9 cases per 10 million people, with prevalence increasing after 50 years of age 4–6 . The maxillary and mandibular branches of the trigeminal nerve are most affected, while the ophthalmic division is affected in <5% 7 . First line treatment for TN is the sodium channel blockers including carbamazepine (CBZ) and oxcarbazepine (OXC) 8 .…”

“…[4][5][6] The maxillary and mandibular branches of the trigeminal nerve are most affected, while the ophthalmic division is affected in <5%. 7 First line treatment for TN is the sodium channel blockers including carbamazepine (CBZ) and oxcarbazepine (OXC). 8 For patients with refractory TN who do not respond to medical treatment or not tolerate the side effects, neurosurgical interventions should be referred as second line treatment ranging widely from microvascular decompression (MVD) to percutaneous trans-foramen ovale (FO) techniques of gasserian ganglion.…”

Long-term outcomes and predictors of percutaneous radiofrequency thermocoagulation of Gasserian ganglion for maxillary trigeminal neuralgia: a retrospective analysis of 1070 patients with minimum 2-year follow-up

“…Central facilitation of trigeminal nociceptive processing and progressive root damage have been proposed as the probably underlying mechanism of untypical pain [ 3 , 4 ]. The maxillary and mandibular branches are most affected, while the ophthalmic division is affected in <5% [ 5 ]. First line treatment for TN is the pharmacological therapy [ 6 ].…”