Combination of Pulsed Radiofrequency with Continuous Radiofrequency Thermocoagulation at Low Temperature Improves Efficacy and Safety in V2/V3 Primary Trigeminal Neuralgia.

BACKGROUND: Primary trigeminal neuralgia (TN) is a common clinical refractory neuralgia. Severe pain is experienced during episodes, severely impacting the patient's quality of life. Long-term suffering from the disease can lead to anxiety, depression, and even suicide. The pathological processes involved in TN are complex, the mechanisms of pathogenesis are unknown, and effective treatment is lacking.

OBJECTIVE: This study aimed to assess the efficacy and safety of computed tomography (CT)-guided pulsed radiofrequency (PRF) combined with low-temperature continuous radiofrequency (CRF) thermocoagulation in V2/V3 primary trigeminal neuralgia.

STUDY DESIGN: This research used a retrospective comparative study design.

SETTING: The research took place at Shengjing Hospital of China Medical University.

METHODS: A total of 80 hospitalized patients with TN were selected between January 2014 and December 2015 and randomly assigned to 2 groups differentiated by therapeutic method: CRF (CRF group, n = 40) and PRF + CRF (PCRF group, n = 40). Radiofrequency therapy was performed under the guidance of CT. Follow-up measures assessed preoperative conditions, pain remission, complications and side effects, recovery time, and recurrence rate over the 2 years following the surgery.

RESULTS: The Visual Analog Scale (VAS) scores decreased in both groups after surgery. After one month, the decrease in the VAS score in the PCRF group was more apparent, and this difference was maintained for 2 years. The total efficiency rates in the CRF and PCRF groups were 85% and 97.5%, respectively, at 6 months, 1 year, and 2 years post-surgery. The differences in total efficiency rate of pain between the 2 groups at 6 months, 1 year, and 2 years were statistically significant. Recovery times in the PCRF group were shorter than those in the CRF group. Specifically, recovery times for facial numbness in the CRF and PCRF groups were 3.12 ± 1.21 months and 2.23 ± 1.02 months, respectively. Recovery times for masticatory muscle weakness were 4.33 ± 1.54 months and 3.42 ± 0.98 months, respectively.

LIMITATIONS: This study is limited by being a retrospective study, and by having a relatively small sample size from a single center.

CONCLUSIONS: CT-guided PRF combined with low-temperature CRF thermocoagulation for treating V2/V3 primary TN effectively relieves pain, increases late-stage pain remission rate, reduces complications, and reduces the rate of recurrence.

KEY WORDS: Complication, continuous radiofrequency thermocoagulation, pulsed radiofrequency, recurrence rate, trigeminal neuralgia, Visual Analog Scale.