The Effectiveness and Safety of Thermocoagulation Radiofrequency Treatment of the Ophthalmic Division (V1) and/or Maxillary (V2) and Mandibular (V3) Division in Idiopathic Trigeminal Neuralgia: An Observational Study

Abstract

Background: Trigeminal neuralgia (TN) is a pain appearing in the ophthalmic (V1), maxillary (V2), and mandibular (V3) trigeminal branches. Pharmacologic treatment is the first line for TN; however, many patients prefer to receive minimally invasive treatment rather than medicine because of intolerable side effects. Thermocoagulation radiofrequency (TRF) is a minimally invasive treatment that has been shown to effectively treat the maxillary (V2) and mandibular (V3) divisions, but the safety of TRF treatment of the ophthalmic (V1) division has been controversial. Objective: This study was to observe the effectiveness and safety of TRF treatment of the ophthalmic (V1) division of trigeminal branches in idiopathic TN patients. Study Design: An observational study. Setting: All of patients received temperature controlled TRF, the effectiveness and safety of TRF was assessed by VAS and complications. Methods: Eighty patients with ophthalmic division (V1) or ophthalmic division (V1) combined with maxillary (V2) or mandibular (V3) divisions of idiopathic TN were treated with step-increased temperature TRF for 6 minutes. At a pulse width of 20 ms, the temperature was titrated up 2 degrees from 60 degrees to 66 degrees every 60 seconds, and then another 66 degrees or 68 degrees for 2 minutes. Meanwhile, the tip of the cannula was turned 180 degrees with each temperature titration. Patients were assessed for pain relief and corneal reflex, numbness, and masticatory muscle weakness at one week, one month, and 3 months after the procedure. Results: Eighty patients were successfully treated with temperature controlled TRF for ophthalmic (V1) division. Excellent pain relief was achieved in 79 of 80 patients (98.75%) after one week, one month, and 3 months, and 78 of 80 patients (97.5%) patients experienced tolerable numbness. Only one patient lost the corneal reflex, 14 experienced a corneal reflex that was mildly decreased, and 2 patients felt a foreign body sensation in the ipsilateral eye after TRF, but there were no corneal ulcers, incidences of blindness, or other complications. Limitations: This study is limited by being an observation study and a non-prospective trial with a short-term follow-up period. Conclusion: Temperature controlled TRF to the ophthalmic division (V1) of the semilular ganglion is effectiveness and safe in TN. Key words: Thermocoagulation radiofrequency, pulsed radiofrequency, trigeminal neuralgia, ophthalmic division, trigeminal ganglion, pain, numbness, corneal reflex

Microvascular Decompression versus Radiofrequency Ablation in Trigeminal Neuralgia of the Maxillary and Mandibular Divisions

“…In their systematic review of the efficacy and safety of percutaneous approaches in the management of TN, Texakalidis et al emphasized that when solely targeting the maxillary division, 31 it was difficult to contain the thermocoagulatory damage from reaching the ophthalmic or mandibular divisions and its real-time detection. [31][32][33] Tang et al in their study, which enrolled older patients above 70 years of age, reported an excellent pain relief in all their patients at discharge, with 49% maintaining pain relief even after 10 years. 34 Zhao et al in their RF series of 1,070 patients reported a pain-free rate in 70.2% of the patients at 10 years and reported that patients prone to long-term pain recurrence are those having initial poor response to medications, patients with atypical facial pain, and patients with previous facial numbness.…”

Effectiveness and Safety of Radiofrequency Thermocoagulation Treatment Guided by Computed Tomography for Infraorbital Neuralgia Following Failed Conservative Treatment: A Retrospective Study

“…In addition, postoperative side effects such as facial swelling, facial numbness, ecchymosis, hematoma at puncture site, eye injury, blindness or infection were also recorded. The degree of facial numbness was scored as follows: 27 0: no numbness; 1: mild numbness (with no significant impact on life); 2: moderate numbness (with some impact on life); and 3: severe numbness (intolerable).…”

New insight into the mandibular nerve at the foramen ovale level for percutaneous radiofrequency thermocoagulation

“…The objective of improving both clinical outcomes and safety has promoted a shift in the treatment strategy in percutaneous RFTC for TN from intracranial localization to selective extracranial localization of individual divisions [ 12 ]. The transfer of interventional targets from the intracranial ganglion to the extracranial trigeminal nerve has been reflected in recent studies that used the extracranial within-FO approach to selectively destroy the MN [ 13 – 15 ].…”