The Long-Term Outcome of 3-Dimensional CT-Guided Percutaneous Radiofrequency Thermocoagulation for Tumor-Related Trigeminal Neuralgia

Abstract

Background: Percutaneous radiofrequency thermocoagulation (PRFT) has been widely used to treat trigeminal neuralgia. By querying MEDLINE, EMBASE, and the Cochrane Library, no study has reported the long-term outcome of PRFT for tumor-related trigeminal neuralgia (TRTN). Objectives: In this study, we aimed to evaluate the long-term efficacy and safety of PRFT as an alternative treatment for TRTN. Study Design: A retrospective study. Setting: The interventional pain management center in Beijing Tiantan hospital. Methods: We retrospectively analyzed data of all patients who underwent PRFT applied to the Gasserian ganglion under computed tomography guidance for TRTN through a combination of available institutional electronic medical records, patient notes, and radiologic images. Results: Among 38 patients with PRFT treated between March 2007 and February 2018, 13 patients were men and 25 were women. All patients were evaluated as modified Barrow Neurological Institute (BNI) IV-V before the operation and had a total symptom duration of 45.55 ± 23.31 months. The mean operation duration was 59.63 ± 16.89 minutes. All patients experienced satisfactory pain relief defined as a classification of BNI I-IIIb within 3 days after PRFT. The median remission length with satisfactory pain relief was 33 (range, 4-132) months. No serious intraoperative complications, except bradycardia in 6 patients, were recorded. Postprocedure complications, including masticatory muscle weakness, were reported in 5 patients. Although all 38 patients experienced facial dysesthesia, the patients’ Likert scale rating represented that quality of life significantly increased after the procedure. Limitations: The small sample size may have unavoidably caused selection bias in our study. Larger prospective, randomized, multicenter trials are necessary to validate our outcomes. Conclusions: PRFT is an effective and safe treatment that should be considered as an alternative for pain control in the treatment of TRTN. Key words: Pain, secondary trigeminal neuralgia, radiofrequency thermocoagulation, trigeminal neuralgia

Computed tomography-guided Gasserian ganglion interventions for cancer-related facial pain in patients with complex anatomy: Insights and recommendations

“…The present study showed a significant reduction in NRS (7.6-3.2; P < 0.001) and DN4 (4.4-2.2; P < 0.001) scores and most patients reported being satisfied. Our results are consistent with those of previous studies [10][11][12][13][14]. Regarding clinical presentation, we obtained similar results, with the right branch being the most affected, specifically V2 + V3 [15,16].…”

“…Unlike previous studies, we included patients with bilateral pain treated with chemical neurolysis, which demands a higher anatomic understanding and skills. Nevertheless, similar to these studies, we reproduced an effective and safe CT-guided technique [ 12 – 14 ]. We achieved 100% technical success with appropriate needle positioning with a significant reduction in pain.…”

“…In contrast, Telischak et al [ 14 ] reported minor complications, such as throat numbness, which can be explained by the combined approach of the Gasserian and glossopharyngeal nerves. Zheng et al [ 12 ] reported that facial dysesthesia was the most common complication. This was the only complication reported in our patients.…”

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

“…Although the patients suffered from varying degrees of facial numbness, most patients claimed that they would prefer numbness over pain. 37 , 40 We speculated that the reason why facial numbness score decreased over time was because patient’s adaptation to numbness or potential nerve repair. However, a considerable number of patients still suffered from numbness one year after RFT treatment, and the ideal therapeutic parameters for reducing numbness should be further explored in the future.…”

Minimally invasive interventional therapy for pain

“…A study by Chen Zheng 8 et al. assessed the long-term efficacy and safety of percutaneous radiofrequency thermocoagulation (PRFT) as an alternative therapy for TN.…”