Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: A double blinded comparative study.

Abstract

Recurrent trigeminal neuralgia (RTN) is a common clinical problem and pain recurs in many patients after microvascular decompression (MVD). We evaluated the effect of adding pulsed radiofrequency to radiofrequency thermocoagulation at 60°C compared to radiofrequency thermocoagulation at 70°C alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression. 40 patients with recurrent trigeminal neuralgia after microvascular decompression were randomly divided into two equal groups. Group A: received prolonged duration of pulsed radiofrequency followed by less destructive thermocoagulation, while group B: received sole thermocoagulation. Then patients followed up for 2years to evaluate the success rate by the Barrow Neurological Institute Pain Intensity (BNI) Scale, complications, and the need to medical treatment. The success rate was 100% in both groups at discharge (BNI<III). It was 83.3% and 78.7% after 6months, 77.8% and 68.4% after 12month, 72.2% and 68.4% after 18months and 66.7% and 63.1% after 24months in group A and B, respectively (p>.05). In group A 88.9% of patients stopped tegretol treatment after the procedure compared to 84.2% in group B (p=.32). 88.9% compared to 89.5% % in group A and B, respectively, did not use tricyclic antidepressant (p=.61). The overall complications in group A was 5.61%, while it was 36.8% in group B (p=.025). Combined pulsed and thermal radiofrequency can significantly reduce the incidence of the side effects/complications with similar success rate than using thermal radiofrequency alone in treatment of recurrent trigeminal neuralgia after microvascular decompression.