Radiofrequency neurolysis in foramen ovale with extracranial non-semilunar ganglion for treatment of trigeminal neuralgia of mandibular branch

Abstract

Objective To observe the clinical effect of extracranial radiofrequency thermocoagulation in foramen ovale on trigeminal neuralgia of mandibular branch. Methods The clinical data of 107 patients with primary trigeminal neuralgia of mandibular branch, admitted to our hospital from January 2016 to December 2017, were collected. With oxygen inhalation and vital signs monitoring, percutaneous radiofrequency thermocoagulation of foramen ovale was performed under CT guidance. The inclination angle, puncture angle and depth, puncture operation time, intra-operative complications, and short-term and long-term results after operation were observed. Results All patients were punctured to the inside and the outside foramen of foramen ovale precisely under the guidance of CT location, and the inclination angle (angle between the puncture needle and the coronal plane), puncture angle (angle between the puncture needle and the sagittal plane), average puncture depth and average puncture operation time were (18.2±7.6)°, (15.9±4.6)°, (63.48±11.7) mm and (13.6±5.7) min, respectively. The pain in mandibular branch dominant area disappeared completely in 104 patients after radiofrequency thermocoagulation at 90 ℃ 120 seconds, and the sensation of needling in this area decreased; two patients had residual pain in anterior ear and temporal area, and one patient had residual pain in lingual tip side, which was cured after radiofrequency treatment again. No intracranial hemorrhage and infection complications occurred except for 21 with facial hematoma during operation. Follow up for 12-24 months showed 9 were recurrence. Conclusion For patients with primary trigeminal neuralgia of mandibular branch, the target of radiofrequency therapy should be transferred from intracranial ganglion to extracranial trigeminal foramen (foramen ovale) for extracranial non-semilunar radiofrequency thermocoagulation therapy, which can obtain satisfactory results and improve the safety of radiofrequency therapy for trigeminal neuralgia. Key words: Trigeminal neuralgia; Foramen ovale; Radiofrequency neurolysis