Abstract
Background: Percutaneous radiofrequency thermocoagulation (PRT) is used to treat trigeminal neuralgia (TN) with a satisfactory pain relief but a high recurrence rate.Objective: To explore the efficacy and safety of repeated PRT for recurrent TN as compared to patients who received the first PRT.Methods: Between January 2013 to May 2013, 31 patients with recurrent TN who have been treated with PRT previously were recruited and underwent repeated PRT (group A), and compared with 41 TN patients received the first initial PRT (group B). Visual Analog Scale (VAS) score was assessed preoperatively and postoperatively after 2 years of follow-up, and compared in terms of initial pain relief, complications, and recurrence rate between the two groups.Results: In group A, 27 patients (87.0%) were pain free immediately, and 30 patients (96.8%) experienced pain relief at 48 h, whereas that was 37 patients (90.0%) and 40 patients (97.6%) in group B (p ≧ 0.05). Patients in group A who remained an “excellent” or “good” pain relief condition (VAS score ≦ 1) were 96.8% at 6 months, 83.9% at 1 year, 74.2% at 2 years, whereas the percentage in group B was 97.6, 85.4, and 73.2% (p ≧ 0.05).Conclusion: For patients with recurrent TN after PRT, repeated PRT might be considered as a useful treatment option when other treatments fail. In addition, the frequency and severity of adverse events for repeated PRT were similar as compared to initial PRT.
Highlights
Trigeminal neuralgia (TN), called as “tic douloureux,” is a sudden, usually unilateral, severe, brief, stabbing, and recurrent pain in the distribution of the trigeminal nerve with a prevalence of 4 per 100,000 in the general population [1]
All the patients were selected based on the following criteria: [1] primary TN of maxillary and/or mandibular divisions over one year based on symptoms described by the International Headache Society Classification, [2] failure of pharmacological management by multiple antiepileptic drugs or recurrence after percutaneous radiofrequency thermocoagulation (PRT), [3] a pain visual analog scale (VAS) score over 7/10 and with a poor quality of life because of the pain, [4] any one or more of the following: poor candidacy for general anesthesia, suboccipital craniotomy, patient preference to avoid craniotomy for microvascular decompression (MVD), and [5] normal brain magnetic resonance imaging
TN is a disorder of the trigeminal nerve that results in intense episodic pain, which deteriorates the quality of life
Summary
Trigeminal neuralgia (TN), called as “tic douloureux,” is a sudden, usually unilateral, severe, brief, stabbing, and recurrent pain in the distribution of the trigeminal nerve with a prevalence of 4 per 100,000 in the general population [1]. Drug therapy, percutaneous radiofrequency thermocoagulation (PRT) of trigeminal ganglion [2], glycerol injection, balloon compression, stereotactic radiosurgery, and microvascular decompression (MVD) have been used to treat TN. The first-line therapy is pharmacological therapy as it is immediately available and usually effective in most cases. When pharmacological therapy fails due to either poor pain control or intolerable side effects, other techniques such as PRT and MVD are often considered. Percutaneous radiofrequency thermocoagulation (PRT) is used to treat trigeminal neuralgia (TN) with a satisfactory pain relief but a high recurrence rate
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