<p>Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis</p>

Abstract

ObjectiveThe objective of this study was to summarize the effectiveness and safety of trigeminal neuralgia (TN) treatment via different radiofrequency approaches such as continuous radiofrequency (CRF), pulsed radiofrequency (PRF), and combined CRF and pulsed radiofrequency (CCPRF) treatments, thus providing high-quality clinical evidence for TN treatment.MethodsA series of databases were searched for relevant articles published between January 1998 and April 2018. The modified Jadad scale was referred to evaluate the methodological quality of the included studies. Data were extracted independently, and the outcome and safety of different routes, temperatures, and guidance used in CRF, PRF, and CCPRF were compared. Meta-analysis and publication bias were calculated using Review Manager software.ResultsIn total, 34 studies involving 3,558 participants were included. With regard to TN treatment, PRF had no difference in cured rate in comparison with CRF, while CRF was more effective than CCPRF (P<0.05). The comparison of complication rates showed that PRF and CCPRF were safer. For puncture guidance via CRF, three-dimensional-printed template was more accurate in success rate at first puncture than computed tomography guidance (P<0.05). For puncture route, foramen rotundum (FR) or pterygopalatine fossa (PPF) route had no significance in efficiency rate via CRF in comparison with foramen oval (FO) route, but PPF and FR routes were safer. For CRF treatment, low temperature (68°C–70°C) compared with high temperature (71°C–75°C) had no effect. Moreover, higher temperature (66°C–80°C) had a greater effect compared with lower temperature (55°C–65°C) on TN treatment (P<0.05), while the safety of which was decreasing.ConclusionCCPRF could achieve a greater effect and safety on TN treatment. FR and FO routes in TN puncture treatment via CRF are safer. Medium temperature range is better for CRF therapy, and higher temperature is recommended in PRF, especially for the elders. Further international multicenter trials are needed to confirm the evidence.

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

“…ese findings suggested that with high temperature of Table 3: Numbness degree on day 1 and at 2 y after operation between the two groups (n(%)). [15][16][17]. In this study, high temperature (95°C) was adopted for radiofrequency therapy to reduce thermal attenuation caused by the distance from the radiofrequency target and target nerve, which in turn leads to incomplete nerve destruction and high relapse rate.…”

Termolezja — interwencyjna metoda leczenia przewlekłego bólu: mechanizmy działania przeciwbólowego, wskazania oraz zastosowanie w wybranych zespołach bólowych

“…A new method (CCRF, combined application of CRF and PRF) consisting of the application of conventional and pulsed radiofrequency in one procedure has been reported in the recent years. According to some authors, this technique is considered to be an equally effective and safe method of pain treatment in trigeminal neuralgia [24,25].…”

“…Imaging techniques have developed significantly in the recent years and computed tomography (CT) is applied alongside fluoroscopy, as well as semi-conductor laser locators and 3D-printed template guidance. This allows the procedure to be shortened significantly and increases the comfort and the safety of the patient during the procedure [24].…”

“…W ostatnich latach została przedstawiona nową metoda (CCRF, combined application of CRF and PRF), polegająca na zastosowaniu konwencjonalnej i pulsacyjnej termolezji w trakcie jednego zabiegu. Według niektórych autorów technika ta jest równie skuteczną i bezpieczną metodą leczenia bólu w trójdzielnej neuralgii [24,25].…”

“…Techniki obrazowania rozwinęły się znacząco w ostatnich latach i tomografia komputerowa (CT, computed tomography) stosowana jest obok fluoroskopii, lokalizatorów wykorzystujących laser półprzewodnikowy oraz szablon prowadzący wydrukowany za pomocą drukarki 3D. Pozwala to na znaczące skrócenie zabiegu i zwiększa komfort oraz bezpieczeństwo pacjenta w trakcie jego trwania [24].…”