Comparison of the Efficacy of Percutaneous Balloon Compression and Extracranial Non gasserian Ganglion Radiofrequency Thermocoagulation for Primary Multibranch Trigeminal Neuralgia.

BACKGROUND: Both computed tomography-guided extracranial nongasserian ganglion radiofrequency thermocoagulation (RFT) and percutaneous balloon compression (PBC) have significant clinical efficacy in the treatment of trigeminal neuralgia, but a comparison of the efficacy of the 2 methods for pain in primary multibranch trigeminal neuralgia (TN) has not been studied clinically.

OBJECTIVE: To compare the efficacy and safety of PBC with extracranial nongasserian ganglion RFT in the treatment of primary multibranch TN.

STUDY DESIGN: This is a single-center, retrospective, observational study.

SETTING: This study was conducted at the Pain Department of the Affiliated Hospital of Jiaxing College in Jiaxing, People's Republic of China.

METHODS: A total of 202 patients, including 112 patients in the RFT group and 90 patients in the PBC group, with multi-branch TN who visited the pain department of Jiaxing First Hospital for percutaneous minimally invasive surgery from April 2016 through June 2021 were retrospectively analyzed. Patients in both groups were followed-up regularly after surgery, and the Numeric Rating Scale, recurrence-free survival rate, Barrow Neurological Institute facial numbness score, and other postoperative complications were recorded before surgery (T0), immediately after surgery (T1) and at 3 months (T2), 6 months (T3), 12 months (T4), and 15 months (T5) postoperatively.

RESULTS: All patients completed the operation successfully. No significant difference was found between the two groups in terms of gender, age, pain duration, preoperative Numeric Rating Scale (NRS-11), lateralization of pain and affected branches, and preoperative underlying disease (P > 0.05). There was a significant difference in preoperative and immediate postoperative NRS-11 scores between the 2 groups (P < 0.01). NRS-11 scores decreased at each time point (T1-T5) and were significantly different from preoperative scores (P < 0.001). Meanwhile, no significant difference was found in NRS-11 scores at T0, T1, and T2 between the RFT and PBC groups (P > 0.05). However, the differences were statistically significant at T3 (P < 0.05), T4 (P < 0.001), and T5 (P < 0.001). BNI-N scores decreased in both groups at T2, T3, T4, and T5 after surgery and were significantly different from preoperative scores (P < 0.05). BNI-N scores were significantly lower in the PBC group than in the RFT group at all time points (P < 0.05). In the long-term treatment of multibranch trigeminal neuralgia, the PBC group exhibited a lower recurrence rate than the RFT group. No severe complications or deaths were observed in either of the 2 groups.

LIMITATIONS: A small sample size and being conducted at a single center are limitations of our study.

CONCLUSION: Both RFT and PBC were effective in relieving primary multibranch TN, but patients in the PBC group had a lower recurrence-free survival rate, fewer complications, and a better safety profile. Follow-up studies with a larger patient sample held at multiple locations should be conducted.

KEY WORDS: Radiofrequency thermocoagulation, percutaneous balloon compression, trigeminal neuralgia, extracranial nongasserian ganglion, multibranch pain.