Factors Associated With Long-term Risk of Recurrence After Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion for Patients With Trigeminal Neuralgia

Abstract

Objective: This study aimed to estimate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of the Gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up. Materials and Methods: We performed a multicenter retrospective analysis of data from 1481 patients with TN who underwent RFT from 2005 through 2017. Recurrence-free survival (RFS) was assessed by the Kaplan-Meier method. Risk factors of all patient characteristics were determined by using univariate and multivariate Cox regression analysis. Prognostic value was determined by prognostic index (PI) with regression coefficients and receiver-operating characteristic curve model. Results: The median of RFS was 136 months (95% confidence interval [CI]: 123.5-148.5). The rate of RFS was 85.3% (95% CI: 83.5%-87.1%) at 1 year, 74.6% (95% CI: 72.2%-77.0%) at 3 years, 68.0% (95% CI: 65.5%-70.5%) at 5 years, and 54.9% (95% CI: 51.6%-58.2%) at 10 years. Multivariate analysis showed that atypical facial pain (hazard ratio [HR]=16.914, 95% CI: 13.117-21.808, P<0.001), Barrow Neurological Institute (BNI) Class II/III facial hypesthesia before undergoing RFT (HR=2.47, 95% CI: 1.52-4.016, P<0.001)/(HR=3.288, 95% CI: 1.035-10.433, P=0.044), and history of previous microvascular decompression/RFT/neurosurgeries≥2 (HR=1.642, 95% CI: 0.941-2.863, P=0.041)/(HR=2.808, 95% CI: 1.819-4.334, P<0.001)/(HR=3.83, 95% CI: 1.802-8.146, P<0.001) were independently associated with RFS. Patients with PI>0.764 were identified as high-risk patients for TN recurrence with a median RFS of 36 months (95% CI: 23.9-48.1) compared with those with PI<0.764 (HR=6.785, 95% CI: 5.371-8.573, P<0.001). Discussion: Our results indicated the patients with a higher risk for recurrence after RFT for the treatment of TN. In addition, our findings might provide support for clinical decision-making before the RFT procedure.

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

“…The recurrence rate was 29% with a 14‐year follow‐up period. Compared with our previous research, the recurrence rate was lower than that with RFT for patients with TN 3 . The other reported recurrence rate for TN with isolated or concomitant V1 division was 30% to 60% after RFT, and no correlation was found with RFT temperature, which was consistent with our findings 16 .…”

“…BNI class II facial hypesthesia could result from long‐term medication and a history of at least 2 past neurosurgeries that caused nerve damage due to the operation 25 . These risk factors were consistent with our previous report, and the highest HR was for the previous history of neurosurgeries 3,26 . For further study, the pathophysiological changes of recurrent TN were especially important and should be considered.…”

“…For the 276 patients with TN involving the ophthalmic division with the treatment of RFT, 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, respectively. The results were consistent with our previous study of 1,481 patients with TN in which the rate of RFS was 85.3% (95% CI 83.5% to 87.1%) at 1 year, 74.6% (95% CI 72.2% to 77.0%) at 3 years, 68.0% (95% CI 65.5% to 70.5%) at 5 years, and 54.9% (95% CI 51.6% to 58.2%) at 10 years 3 . That study showed that RFT had good initial pain relief and a similar long‐term follow‐up result for each division pain in TN, but the eye complication was obvious and severe for TN involving the ophthalmic division.…”

“…Among them, RFT is the most cost effective. However, more complications relative to thermocoagulation, such as facial numbness, facial paresthesia, masseter weakness, decreased corneal reflex, and keratitis, are also observed after RFT procedures 3,4 . For TN involving the ophthalmic division, the incidences of decreased corneal sensation (5.7% to 17.3%) and keratitis (0.6% to 1.9%) are higher among patients undergoing RFT than among those undergoing PBC 5 .…”

The Comparison of Efficacy and Complications of Coblation and Radiofrequency Thermocoagulation for V2/V3 Idiopathic Trigeminal Neuralgia: A Retrospective Cohort Study of 292 Cases

“…Despite the slightly lower remission rate in coblation group, there was no statistically signi cant difference. Some literature review reported that the remission rate after RFT 22,24 ranged from 50.4-80.7% in a follow-up of 5 years. However, as a relatively novel technique for the treatment of ITN, it was di cult to perform the long-term results according to the available and limited clinical data.…”