Long-term Follow-up of Patients Treated with Percutaneous Radiofrequency Thermocoagulation via the Foramen Rotundum for Isolated Maxillary Nerve Idiopathic Trigeminal Neuralgia

Abstract

Objective The purpose of this study is to evaluate the effectiveness and safety of percutaneous radiofrequency thermocoagulation (PRT) via the foramen rotundum (FR) for the treatment of isolated maxillary (V2) idiopathic trigeminal neuralgia (ITN) and assess the appropriate puncture angle through the anterior coronoid process to reach the FR. Methods Between January 2011 and October 2016, 87 patients with V2 ITN refractory to conservative treatment were treated by computed tomography (CT)–guided PRT via the FR at our institution. The outcome of pain relief was assessed by the visual analog scale (VAS) and Barrow Neurological Institute (BNI) pain grade and grouped as complete pain relief (BNI grades I–III) or unsuccessful pain relief (BNI grades IV–V). Recurrence and complications were also monitored and recorded. The puncture angle for this novel approach was assessed based on intraoperative CT images. Results Of the 87 treated patients, 85 (97.7%) achieved complete pain relief, and two patients (2.3%) experienced unsuccessful pain relief immediately after operation. During the mean follow-up period of 44.3 months, 15 patients (17.2%) experienced recurring pain. No severe complications occurred, except for hypoesthesia restricted to the V2 distribution in all patients (100%) and facial hematoma in 10 patients (11.5%). The mean puncture angle to reach the FR was 33.6° ± 5.7° toward the sagittal plane. Discussion CT-guided PRT via the FR for refractory isolated V2 ITN is effective and safe and could be a rational therapy for patients with V2 ITN.

Effects of Supraorbital Foramen Variations on the Treatment Efficacy of Radiofrequency Therapy for V1 Trigeminal Neuralgia: A Retrospective Study

“…e definition of "effective" for the treatment of trigeminal neuralgia varied in different studies [21][22][23]. For instance, some studies have defined "effective" as pain remission by >50% after treatment [24,25]. However, the primary trigeminal neuralgia manifests as typical neuropathological pain, mainly as paroxysmal shock-like intense pain which is characterized as "all-or-none."…”

Supraorbital Nerve Radiofrequency for Severe Neuralgia Caused by Herpes Zoster Ophthalmicus

“…Before the operation and at 1, 30, 90, 180, and 360 days after the operation, the following data were recorded routinely: NRS, occurrence of spontaneous pain, occurrence of allodynia, gabapentin dosage, paracetamol/oxycodone dosage, the patient global impression of change (PGIC) score [ 21 ], the Barrow numbness score [ 22 ], postoperative 360-day recurrence rate (recurrence refers to the NRS equal to or greater than that before operation), and complications (such as subcutaneous swelling of the supraorbital area, eyelid droop, corneal ulcer, and eyeball damage). The recurrence and complications were obtained from the patient charts.…”

The comparison of efficacy and complications of coblation and radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia: a retrospective cohort study of 292 cases

“…However, people are more likely to accept minimally invasive treatment like radiofrequency thermocoagulation (RFT), which has been widely used in the elderly who suffer from facial pain of trigeminal neuralgia, rather than the surgery that requires craniotomy and tracheal intubation. Although the remission rate of RFT is satisfactory at a 1-year follow-up, the recurrence rate of RFT ranges from 15 to 46% [11,12] during long-term follow-up, with a multitude of patients complained about the facial numbness after RFT. Coblation is a novel technique, which was widely used in intraoperative tissue cutting of otolaryngology [13] and other fields.…”