Percutaneous Radiofrequency Thermocoagulation Research Articles

Establishment of a Clinical Prediction Model Based on the Study of Risk Factors for Pain Recurrence after Percutaneous Radiofrequency Thermocoagulation in Patients with Primary Trigeminal Neuralgia

Objectives: This study aimed to investigate the follow-up outcomes and risk factors associated with pain recurrence after percutaneous radiofrequency thermocoagulation (PRT) among patients with primary trigeminal neuralgia (PTN) and to establish a clinical prediction model based on these risk factors. Methods: The data of PTN patients who underwent PRT were collected in our study. All subjects were randomly divided at a 7:3 ratio into a training group (T Group) and a test group (C Group) to select risk factors. According to the follow-up results, the patients were divided into a recurrence group (F Group) and a nonrecurrence group (NF Group). Predictive factors were selected through LASSO regression analysis based on T Group. The identified variables were subjected to multivariate logistic regression analysis to construct a nomogram. Receiver operating characteristic (ROC) curves and calibration curves were uesd to evaluate discrimination and calibration ability separately. Results: A total of 884 patients were initially included, 857 patients achieved satisfactory results, and the pain relief rate at discharge was 96.95%. A total of 529 subjects were included after screening, and the recurrence rate was 27.22% after 1 year. Six non-zero variables were selected through LASSO regression analysis: the disease course, atypical pain, previous surgery, facial numbness before PRT, neurovascular contact (NVC), and operation duration. Six variables were included in the multivariate logistic regression analysis, and the results showed that they were independent risk factors (P<0.05). The predictive model is represented by a nomogram. The area under the curves (AUC) of the ROC curves were 0.868 (0.826~0.909) and 0.874 (0.802~0.950) for T Group and C Group, respectively. The prediction curves for T Group (P=0.784) and C Group (P=0.293) fit the ideal prediction curve, and the Brier scores were 0.120 and 0.099 for T Group and C Group, which indicates that the probability predicted by the model is consistent with the actual occurrence. Conclusion: The Pain relief rate at discharge was 96.95% for PTN patients after PRT, and the recurrence rate was 27.22% after 1 year. The disease course, atypical pain, previous surgery, facial numbness before PRT, NVC, and operation duration are independent risk factors for the recurrence of pain. A nomogram model for pain recurrence was established, which has good predictive ability.

Comparison of initial percutaneous balloon compression versus radiofrequency thermocoagulation followed by percutaneous balloon compression in the treatment of trigeminal neuralgia.

There are a variety of minimally invasive interventional treatments for trigeminal neuralgia, and the efficacy evaluation is different. The preferred treatment scheme is still controversial. This study aims to investigate the differences in treatment effects between patients with primary trigeminal neuralgia (PTN) treated with percutaneous balloon compression (PBC) for the first intervention and patients with pain recurrence after radiofrequency thermocoagulation (RT) who then received PBC for PTN, and to offer clinicians and patients more scientifically grounded and precise treatment alternatives. We retrospectively analyzed 103 patients with PTN admitted to the Department of Pain Management of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to December 2021, including 49 patients who received PBC for the first time (PBC group) and 54 patients who received PBC for pain recurrence after RT (RT+PBC group). General information, preoperative pain score, intraoperative oval foramen morphology, oval foramen area, balloon volume, duration of compression, and postoperative pain scores and pain recurrence at each time point on day 1 (T1), day 7 (T2), day 14 (T3), 1 month (T4), 3 months (T5), and 1 year (T6) were collected and recorded for both groups. The differences in treatment effect, complications and recurrence between the 2 groups were compared, and the related influencing factors were analyzed. The differences of general information, preoperative pain scores, foramen ovale morphology, foramen ovale area, T1 to T3 pain scores between the 2 groups were not statistically different (all P>0.05). The balloon filling volume in the PBC group was smaller than that in the RT+PBC group, the pain scores at T4 to T6 and pain recurrence were better than those in the RT+PBC group (all P<0.05). Pain recurrence was positively correlated with pain scores of T2 to T6 (r=0.306, 0.482, 0.831, 0.876, 0.887, respectively; all P<0.01). The choice of PBC for the first intervention in PTN patients is superior to the choice of PBC after pain recurrence after RT treatment in terms of treatment outcome and pain recurrence.

Comparative safety and efficacy of percutaneous radiofrequency thermocoagulation and percutaneous balloon compression in CT-guided and local anesthesia for recurrent trigeminal neuralgia.

There are several ways to treat trigeminal neuralgia (TN); however, TN may recur after treatment. Although microvascular decompression (MVD) is considered an effective treatment for trigeminal neuralgia, patients with recurrence may not be willing to undergo craniotomy. This study compared the safety and efficacy of percutaneous radiofrequency thermocoagulation and percutaneous balloon compression for treating recurrent trigeminal neuralgia. This was a prospective non-randomized controlled study. A total of 52 with recurrent TN were scheduled to undergo surgery in our Hospital from January-June 2021. The patients were classified into percutaneous radiofrequency thermocoagulation (PRT) and percutaneous balloon compression (PBC) groups based on the treatment. All surgeries were performed under computed tomography guidance and local anesthesia. Post-operative complications were also observed. Pain was assessed using the visual analog scale (VAS) and Barrow Neurological Institute (BNI) scale. Efficacy indices were evaluated at 3, 6, 12, and 18 months after surgery. During follow-up, the efficacy rates of the two methods within 18 months were 76.0 and 88.9%, respectively. All patients had hypoesthesia on the affected side, and no severe complications. Notably, 5 patients (20%) in the PRT group with multiple-branch pain, including the first branch of the trigeminal nerve (V1) pain in the PRT group, received radiofrequency therapy for the supraorbital notch (foramen) after puncture of the foramen ovale. However, multiple pain episodes resolved with only one operation in the PBC group. CT-guided percutaneous radiofrequency thermocoagulation and percutaneous balloon compression under local anesthesia may be good options for treating recurrent trigeminal neuralgia. Percutaneous balloon compression may be recommended when multiple branches are involved, particularly in cases of V1 neuralgia.

Percutaneous radiofrequency thermocoagulation and microvascular decompression for treating glossopharyngeal neuralgia: a retrospective clinical study

ObjectivesThis study aimed to investigate the differences in the effectiveness of percutaneous radiofrequency thermocoagulation (PRT) and microvascular decompression (MVD) in treating glossopharyngeal neuralgia (GPN).MethodsMedical records of patients were reviewed to investigate their baseline characteristics and immediate postoperative prognosis. Long-term outcomes of these patients were obtained through telephone interviews. Visual analog scale (VAS) and Pittsburgh sleep quality index (PSQI) scores at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were compared between the MVD and PRT groups, in addition to complete pain relief rate, effective rate, adverse reactions, length of hospital stay, and economic indicators.ResultsThe VAS and PSQI scores of the two groups at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were significantly lower (P < 0.05) than those before surgery. At 48 weeks, the complete remission rate was significantly higher (P < 0.05) in the MVD group than in PRT group. No significant difference in adverse reactions was observed between the two groups. The length of hospital stay, operative time, and cost were significantly higher (P < 0.05) in the MVD group than in the PRT group.ConclusionsBoth PRT and MVD can significantly reduce patients’ degree of pain and improve their sleep quality. In the medium term, MVD is better than PRT in terms of the complete curative effect. In young patients with GPN, MVD is more often recommended than PRT; however, MVD is costlier than PRT.

New insight into the mandibular nerve at the foramen ovale level for percutaneous radiofrequency thermocoagulation.

Percutaneous radiofrequency thermocoagulation (RFTC) has been widely utilized in the management of trigeminal neuralgia. Despite using image guidance, accurate needle positioning into the target area still remains a critical element for achieving a successful outcome. This study was performed to precisely clarify the anatomical information required to ensure that the electrode tip is placed on the sensory component of the mandibular nerve (MN) at the foramen ovale (FO) level. The study used 50 hemi-half heads from 26 South Korean adult cadavers. The cross-sectioned anterior and posterior divisions of the MN at the FO level could be distinguished based on an irregular boundary and color difference. The anterior division was clearly brighter than the posterior one. The anterior division of the MN at the FO level was located at the whole anterior (38.0%), anteromedial (6.0%), anterior center (8.0%), and anterolateral (22.0%) parts. The posterior division was often located at the whole posterior or posterolateral parts of the MN at the FO level. The anterior divisions covered the whole MN except for the medial half of the posterolateral part in the overwrapped images of the cross-sectional areas of the MN at the FO level. The cross-sectional areas of the anterior divisions were similar in males and females, whereas those of the posterior divisions were significantly larger in males (P = 0.004). The obtained anatomical information is expected to help physicians reduce unwanted side effects after percutaneous RFTC within the FO for the MN.

The Comparison of General Characteristics and Early and Late Post-intervention Results in Patients With Trigeminal Neuralgia Secondary to Multiple Sclerosis and Idiopathic Trigeminal Neuralgia Treated With Radiofrequency Thermocoagulation.

Aim The aim of this study was to investigate possible differences (in terms of demographic structure, disease history, complaints, clinical findings, early and late treatment outcomes, and complications) between patients with idiopathic trigeminal neuralgia (ITN) and trigeminal neuralgia (TN) secondary to multiple sclerosis (MS) who were admitted to our clinic and underwent radiofrequency (RF) thermocoagulation procedure. Materials and methods Patients who underwent percutaneous radiofrequency thermocoagulation with a diagnosis of trigeminal neuralgia by a single neurosurgeon in a single neurosurgery clinic between January 2005 and January 2020 were included in this study. Patients were divided into two groups: idiopathic trigeminal neuralgia and trigeminal neuralgia secondary to multiple sclerosis (MSTN) according to their diagnosis. In our study, 215 TN patients who underwent 286 procedures were included. These patients were categorized according to age, sex, involved side, pain localization, and pain history. Postoperative complications were determined after each intervention. The early and late results of all interventions were evaluated, and the results were compared between both groups. All results were statistically analyzed. Results Considering the age of the patients, the mean age of the idiopathic group was higher than the multiple sclerosis group (58.18>49.46). In terms of the side of pain, bilateral involvement was significantly more common in the MS secondary group (1.48%<30.77%). There was no significant difference between the early results of both groups. In terms of remission periods, the pain-free period in the MS secondary group was significantly shorter than in the idiopathic group (mean value in months, 30.87>23.81). Conclusion The radiofrequency thermocoagulation of the trigeminal nerve is a highly effective, low-complication, reproducible procedure for trigeminal neuralgia, but the search for ways to improve the efficacy of treatment in MS patients should continue.

Retrospective comparison of percutaneous balloon compression and radiofrequency-thermocoagulation in the management of trigeminal neuralgia

PurposeTo compare percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFTC) for the treatment of trigeminal neuralgia.MethodsThis was a retrospective single-center analysis of data from 230 patients with trigeminal neuralgia who underwent 202 PBC (46%) and 234 RFTC (54%) from 2002 to 2019. Comparison of demographic data and trigeminal neuralgia characteristics between procedures as well as assessment of 1) initial pain relief by an improved Barrow Neurological Institute (BNI) pain intensity scale of I–III; 2) recurrence-free survival of patients with a follow-up of at least 6 months by Kaplan-Meier analysis; 3) risk factors for failed initial pain relief and recurrence-free survival by regression analysis; and 4) complications and adverse events.ResultsInitial pain relief was achieved in 353 (84.2%) procedures and showed no significant difference between PBC (83.7%) and RFTC (84.9%). Patients who suffered from multiple sclerosis (odds ratio 5.34) or had a higher preoperative BNI (odds ratio 2.01) showed a higher risk of not becoming pain free. Recurrence-free survival in 283 procedures was longer for PBC (44%) with 481 days compared to RFTC (56%) with 421 days (p=0.036) but without statistical significance. The only factors that showed a significant influence on longer recurrence-free survival rates were a postoperative BNI ≤ II (P=<0.0001) and a BNI facial numbness score ≥ 3 (p = 0.009). The complication rate of 22.2% as well as zero mortality showed no difference between the two procedures (p=0.162).ConclusionBoth percutaneous interventions led to a comparable initial pain relief and recurrence-free survival with a low and comparable probability of complications. An individualized approach, considering the advantages and disadvantages of each intervention, should guide the decision-making process. Prospective comparative trials are urgently needed.

Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis.

Primary palmar hyperhidrosis (PPH) is a condition marked by an overactive secretion of the hand's exocrine glands and is frequently hereditary. The profuse sweating associated with this condition can significantly impair the patient's daily activities and quality of life. The objective of this study was to compared the benefits and drawbacks of thoracic sympathetic block and thoracic sympathetic radiofrequency in the treatment of PPH. A retrospective analysis was conducted on 69 patients. They were divided into groups A and B according to their treatment. Group A (34 cases) received CT-guided percutaneous thoracic sympathetic nerve chain anhydrous alcohol chemical damage block, and group B (35 cases) received CT-guided percutaneous thoracic sympathetic nerve chain radiofrequency thermocoagulation. Palmar sweating disappeared immediately after the operation. The recurrence rates at 1, 3, 6, 12, 24, and 36 months were 5.88% vs. 2.86% (P > 0.05), 20.59% vs. 5.71% (P > 0.05), 32.35% vs. 11.43% (P < 0.05),32.35% vs. 11.43% (P < 0.05), 25% vs. 14.71% (P < 0.05), and 68.75% vs. 20.59% (P < 0.05), respectively. The incidence of intercostal neuralgia and compensatory hyperhidrosis was higher in group A compared with of group B (52.94% vs. 22.86%, P < 0.05; 55.88% vs. 22.86%, P < 0.05). Both methods were found to be effective in treating PPH, but thoracic sympathetic radiofrequency had a longer-term effect, a lower recurrence rate, and a lower incidence of intercostal neuralgia and compensatory hyperhidrosis than a thoracic sympathetic block.

Long-term outcomes and predictors of percutaneous radiofrequency thermocoagulation of Gasserian ganglion for maxillary trigeminal neuralgia: a retrospective analysis of 1070 patients with minimum 2-year follow-up

Objective To estimate long-term efficacy and safety for maxillary trigeminal neuralgia (TN) using radiofrequency thermocoagulation (RFT) targeted on Gasserian ganglion, and to identify the factors which may influence outcomes after procedure. Methods From 2006 to 2019, 1070 patients underwent RFT for the treatment of medically refractory maxillary TN was included. All patients were followed up for at least 2 years. Outcomes and complications were recorded and analysed. Logistic regression analysis was employed to identify risk factors of long-term pain recurrence. Prognostic value was calculated from receiver-operating characteristic curve (ROC). Results Longitudinal analysis was taken place for 97 non-responders (9.1%) with ineffective pain relief, 253 responders (23.6%) with pain recurrence and 720 responders (67.3%) without pain recurrence. The median pain-free survival (PFS) was 112.0 months (95% CI: 107.5, 116.5). The pain-free rates were 89.9% (95% CI: 88.0–91.8%) at 1 year, 83.8% (95% CI: 81.5–86.1%) at 2 years, 75.4% (95% CI: 72.7–78.1%) at 5 years and 70.2% (95% CI: 67.4–73.0%) at 10 years. Atypical facial pain (HR = 5.373, 95% CI: 2.623–11.004, p < .001), previous facial numbness (HR = 5.224, 95% CI: 3.107–8.784, p < .001) and poor initial response to medication (HR = 3.185, 95% CI: 2.087–4.860, p < .001) were independently associated with long-term pain recurrence. Patients with prognostic index (PI) > 0.25 were identified as high-risk for recurrent TN (HR = 5.575, 95% CI: 3.991–7.788, p < .001). New and worsen facial hypoesthesia was recorded in 77.9% of patients corresponding with BNI score II–IV, and 18.7% reported improved sensation. Severe complication incidence including troublesome dysesthaesia, keratitis and masseter weakness was higher in 80 °C group. Conclusions Favourable outcomes were achieved in terms of long-term pain relief and complications rate after RFT for maxillary TN. Patients with typical facial pain, normal facial sensation, and good initial response to medications may have favourable long-term outcomes. Key messages This is a retrospective analysis of radiofrequency thermocoagulation (RFT) targeted on Gasserian ganglion for the treatment of maxillary trigeminal neuralgia (TN) during long-term follow-up. Recurrence-free survival among a large sample was assessed and risk factors associated with long-term pain recurrence was identified. It has been verified that inadvertent damage of ophthalmic and mandibular division causes ophthalmic and masticatory complications. Therefore, a more precise needle tip position and thermocoagulation using a relatively low temperature was recommended.

Efficacy of CT-guided percutaneous stylomastoid foramen puncture through the mandibular angle approach and radiofrequency ablation of facial nerve for the treatment of hemifacial spasm

Objective: To investigate the efficacy of CT-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through stylomastoid foramen for the treatment of hemifacial spasm. Methods: A total of 82 patients with primary facial spasm who underwent CT-guided RFT in the Department of Pain Medicine of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and Department of Pain Medicine of the First Hospital of Jiaxing from January 2019 to June 2021 were retrospectively analyzed, including 27 males and 55 females, aged 24-85 (59±11) years. All patients were divided into three groups according to the different puncture approaches: anterior mastoid approach group (Group A, n=35), posterior mastoid approach group (Group P, n=25) and mandibular angle approach group (Group M, n=22). The puncture time, the minimum stimulating current inducing the twitch of facial muscles on the affected side, the temperature at the end of RFT and the duration of RFT at this temperature, the total treatment time, as well as the degree of facial paralysis and complications 1 day after operation were compared among the three groups. Results: The puncture time of the Group A, Group P and Group M was (31.0±4.9) min, (31.9±6.5) min and (35.3±5.9) min, respectively, and the difference was statistically significant (P=0.020). The puncture time of the Group M was longer than that of the Group A and P (both P<0.05). The minimum stimulation current inducing the twitch of the affected facial muscle in the three groups was (0.5±0.2) mA, (0.4±0.1) mA and (0.3±0.1) mA, respectively, with a statistically significant difference (P=0.000). The minimum stimulation current in the Group M was less than that in the Group A and P (both P<0.05). The temperature at the end of RFT of the three groups was (78.6±8.1) ℃, (76.6±8.3) ℃ and (67.0±8.4) ℃, respectively, and the difference was statistically significant (P<0.001). The temperature of the Group M was lower than that of the Group A and P (both P<0.05). There were no significant differences among the three groups in the duration of RFT at the final temperature, the total treatment time, and the degree of facial paralysis 1 day after operation (all P>0.05). No hematoma, infection, hearing impairment and other complications occurred in all patients. Conclusion: CT-guided percutaneous RFT through stylomastoid foramen is efficacious in the treatment of hemifacial spasm, and the mandibular angle approach provides better performance.

Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options

This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia. An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy. While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.

Long‐term recurrence‐free survival and complications of percutaneous balloon compression and radiofrequency thermocoagulation of Gasserian ganglion for trigeminal neuralgia: A retrospective study of 1313 cases

To estimate long-term recurrence, complications after percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFT) of gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up. A retrospective analysis of 1313 patients undergoing PBC or RFT for the treatment of TN was conducted from 2006 to 2020. Recurrence-free survival (RFS) was assessed by the Kaplan-Meier method. Complications including facial numbness, corneal reflex decrease and masseter weakness were also estimated. For patients who received first initial PBC and RFT, the median RFS was 130.1months (95% CI: 124.4, 135.9) and 123.3months (95% CI: 117.6, 128.9) in PBC and RFT group with log-rank p=0.108. The RFS rate was, respectively, 90.6% (95% CI: 88.1%-93.3%) and 91.4% (95% CI: 89.1%-93.7%) at 1year, 84.6% (95% CI: 81.4%-87.8%) and 83.3% (95% CI: 80.3%-86.3%) at 3 years, 81.5% (95% CI: 78.1%-85.0%), and 78.6% (95% CI: 75.2%-81.9%) at 5 years, 71.5% (95% CI: 67.5%-75.5%), and 64.8% (95% CI: 61.0%-68.7%) at 10 years in two groups. No significant difference was observed in facial numbness degree between two groups after procedure. Compared with PBC group, ophthalmic complication prevalence was higher in RFT group (9.6%) (p=0.001). However, masseter weakness incidence was lower (10.7%) than that in PBC group (24.0%) with p < 0.001. Patients with TN seemed to attain similar long-term benefit from PBC and RFT, especially in elderly. However, in order to reduce postoperative complications, PBC provided a safer and alternative for treating TN involving ophthalmic division, whereas RFT could be employed as a preferred regimen for maxillary and mandibular TN.

Percutaneous Radiofrequency Thermocoagulation in Trigeminal Neuralgia : Analysis of Early and Late Outcomes of 156 Cases and 209 Interventions.

ObjectiveTrigeminal neuralgia is one of the most common causes of facial pain. Our aim is to investigate the efficacy and borders of percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. MethodsBetween May 2007 and April 2017, 156 patients with trigeminal neuralgia were treated with radiofrequency thermocoagulation. These 156 patients underwent 209 procedures. In our study, we investigated the early and late results of percutaneous radiofrequency thermocoagulation under guiding fluoroscopic imaging in the treatment of trigeminal neuralgia. Barrow Neurological Institute (BNI) pain scale was used for grading the early results. In addition, Kaplan-Meier survival analysis was used to assess long-term outcomes. Of the 156 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia, 45 had additional disease. Patients with this condition were evaluated with their comorbidities. Early and late results were compared with those without comorbidity. ResultsIn 193 of 209 interventions BNI pain scale I to III results were obtained. Out of the 193 successful operation 136 patients (65.07%) were discharged as BNI I, 14 (6.70%) as BNI II, 43 (20.58%) as BNI III. Sixteen patients (7.65%) remained uncontrolled (BNI IV and V). While the treatment results of trigeminal neuralgia patients with comorbidity seem more successful in the early period, this difference was not observed in follow-up examinations. ConclusionFinally, we concluded that percutaneous radiofrequency thermocoagulation of the Gasserian ganglion is a safe and effective method in the treatment of trigeminal neuralgia. However, over time, the effectiveness of the treatment decreases. Neverthless, the reapprability of this intervention gives it a distinct advantage.

Sympathectomy with T2-T3 percutaneous radiofrequency thermocoagulation method in upper extremity primary hyperhidrosis cases

Terleme sempatik sinir sistemi tarafından kontrol edilir ve vücudun ısı ve elektrolit dengesini düzenlemeye yardımcı olur. Populasyonun %1 kadarında bir takım nedenlerden dolayı aşırı terleme gözlenebilir. Yaşam kalitesi açısından önemli olan hiperhidrozisin tedavisinde pek çok yöntem kullanılmaktadır. Medikal tedaviye dirençli primer hiperhidrozisli dört hastada, stellat ganglionun anterior yaklaşımla radiofrekans termokoagülasyonu daha sonra da T2-T3 sempatik gangliona radiofrekans termokoagülasyonunun yanıtı değerlendirildi. İşlem süresinin kısa olması, hasta memmuniyeti, hastanede kalış süresinin az olması ve iş güç kaybına neden olmaması diğer cerrahi yöntemlere göre hem daha az invaziv olması hem de maliyetinin daha az olması hastanın genel anestezi almaması açısından avantajlı ve başarılı bir yöntem olduğunu düşünüyoruz. Primer hyperhidrosisin tedavisinde radiofrekans termokoagülasyon yöntemi ile stellat ve T2-T3 sempatektominin kesinlikle faydalı bir teknik olduğunu gördük.

Factors Associated With Long-Term Risk of Recurrence After Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion for Patients With Trigeminal Neuralgia Involving the Ophthalmic Division: A Retrospective Study.

To evaluate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of the gasserian ganglion among patients with ophthalmic trigeminal neuralgia (TN) and prognostic factors in terms of recurrence-free survival (RFS) during a long-term follow-up. From January 2005 to December 2017, 300 patients with ophthalmic TN underwent RFT. A retrospective analysis of 14-year outcomes was performed. Kaplan-Meier analysis was used for RFS after the procedure. Univariate and multivariate Cox regression analyses were performed to identify risk factors for pain recurrence. The initial effective rate of RFT for ophthalmic TN was 92%. The mean follow-up time was 77.38±43.24months. The cumulative probability of RFS was 86.94% at 1year, 80.03% at 2 years, 77.27% at 3 years, 74.01% at 5 years, and 59.92% at 10 years after RFT. The mean duration of RFS was 114.67 months (95% confidence interval [CI] 106.27 to 123.06 months). In multivariate analysis, atypical pain (hazard ratio [HR]=2.831, 95% CI 1.759 to 4.554, P<0.001) and mild facial hypesthesia (HR=2.540, 95% CI 1.309 to 4.931, P=0.006) before RFT were independently associated with pain recurrence. Patients with a prognostic index (PI) >1.27 were at high risk for pain recurrence. Major complications included troublesome dysesthesia (0.7%), keratitis (10.9%), diplopia (0.4%), facial paresthesia (6.2%), and masseter weakness (12.7%). Masseter weakness was more common in patients with V3 branch involvement. Three patients lost their sight due to keratitis. Our study investigated long-term outcomes and complications of RFT for ophthalmic TN. Patients at high risk for pain recurrence were identified, which might provide a basis for clinical decision making before RFT.

Repetitive percutaneous radiofrequency thermocoagulation for persistent idiopathic facial pain and central neuropathic pain attributed to multiple sclerosis-a retrospective monocentric analysis.

Persistent idiopathic facial pain (PIFP) is a debilitating chronic pain condition with pain radiating to trigeminal dermatomes. Typically, there are no pathological findings that can be identified during workup and therapy is symptomatic. Facial pain is common in patients with multiple sclerosis (central neuropathic pain attributed to MS). Our aim was to evaluate the effectiveness of percutaneous radiofrequency thermocoagulation (PRTC) of the gasserian ganglion and the duration of pain relief, as well as the identification of factors associated with its outcome. Data on all the above-mentioned patients that have been treated with PRTC between 2009 and 2019 were included into the study. The outcome was assessed with a six-tiered score from 1 (complete remission) to 6 (no benefit). Univariate and multivariate analyses were performed in order to obtain factors associated with the outcome. A total of 52 patients were included. The total number of procedures performed was 114. 61.5% of patients who experienced temporary pain relief that lasted for a median of 60days (range 3-1490days). In patients with recurrence, the fraction of successful interventions was higher, and also transient, with successful pain amelioration in over 80% of patients. Successful responses to PRTC were observed in 27.9% after 1year, 19.4% after 2years, and 8.3% after 3years. The only independent variable predicting pain relief was a repeat intervention with a history of ≥ 2 interventions (OR: 4.36, 95%-CI: 1.34-14.34, p = 0.015). No severe complications occurred. Our data showed good and immediate pain relief after PRTC in the majority of our patients. PRTC is a low-risk procedure that can be discussed as an option in case of failure of medical treatment even in critically ill patients and can be repeated with good results when necessary. Long-term pain amelioration, even with repeated procedures, was not possible and no patient was permanently cured.

Effectiveness and safety of CyberKnife radiosurgery in treatment of trigeminalgia - experiences of Polish neurological and oncological centres.

Trigeminal neuralgia (TN) is one of the most common cranial neuropathies. Pathologies located alongside the long nerve can also cause its mechanical compression or secondary involvement in the inflammatory process, and thus cause pain. TN is characterised by severe paroxysmal unilateral facial pain in the innervation area of branches I-III of the nerve V when provoked by light touch or slight movement. Multiple therapeutic methods are available, but most of them yield unsatisfactory results. According to guidelines (AAN and EFNS) the first-line therapy in trigeminalgia is carbamazepine/oxcarbazepine, and if there is a poor response - surgical treatment [1]. The array of surgical options includes percutaneous retrogasserian glycerol injection, radiofrequency thermocoagulation, balloon decompression, thermal rhizotomy, and stereotactic radiosurgery [2-4]. This paper presents our own experiences with CyberKnife (CK), a new type of radiosurgical (RS) treatment of 64 TN patients. CONCLUSIONS: CyberKnife radiotherapy is characterised by high efficacy in 80% of patients with trigeminalgia, minimal invasiveness, and subsiding mild side effects. Radioablation of nerve V root in patients with neuralgia allows us to entirely stop antiepileptic therapy or reduce its doses, which in turn reduces the risk of potential side effects. CyberKnife can be a therapeutic option in those patients who have been offered ineffective therapies, or treatments with limited efficacy, and/or in older patients with comorbidities.

Abstract No. 571 Computed tomography–guided percutaneous radiofrequency thermocoagulation for recurrent trigeminal neuralgia: initial experience

Abstract No. 571 Computed tomography–guided percutaneous radiofrequency thermocoagulation for recurrent trigeminal neuralgia: initial experience

Efficacy of coblation versus radiofrequency thermocoagulation for the clinical treatment of trigeminal neuralgia.

IntroductionPostoperative facial numbness is the main complication of radiofrequency thermocoagulation in treating trigeminal neuralgia, which could seriously affect the surgical efficacy. This problem is expected to be resolved by coblation technique.AimTo compare the long-term efficacy and safety of coblation and percutaneous trigeminal radiofrequency thermocoagulation (PT-RFT) under fluoroscopic guidance in the treatment of trigeminal neuralgia (TN).Material and methodsA case-control prospective study was carried out. Patients with TN were randomly scheduled to receive coblation or PT-RFT. Both surgical procedures were performed under fluoroscopic guidance. The data, including the degree of pain, pain relief and complications, were recorded during follow-up evaluation, which was performed on the first day and at the end of the first month, third month, sixth month and first year after surgery.ResultsA total of 50 patients were enrolled in this study, with 25 patients in each group. The visual analog scale (VAS) scores in both groups at each time point after surgery were significantly lower compared with before surgery (p < 0.05). There were no significant differences in VAS scores or pain relief between the two groups at any time point after surgery (p > 0.05). However, patients in the PT-RFT group exhibited greater facial numbness after surgery (p < 0.05). For other complications, there were no significant differences between the two groups (p > 0.05).ConclusionsCoblation and PT-RFT showed similar effectiveness in reducing pain; however, coblation was associated with a lower rate of postoperative facial numbness. Therefore, coblation may be a better treatment option for TN.

Radiofrequency Thermocoagulation Through Foramen Rotundum Versus Foramen Ovale for the Treatment of V2 Trigeminal Neuralgia

Background: Percutaneous radiofrequency thermocoagulation through the foramen rotundum (FR) is a new approach for the treatment of V2 trigeminal neuralgia (TN). Objectives: This study aimed to compare the efficacy and safety of the FR approach with that of the foramen ovale (FO) approach. Study Design: Nonrandomized controlled clinical trial. Setting: The study was conducted at Huaian Hospital of Huaian City, Huaian, China. Methods: From July 2014 to December 2016, 80 consecutive patients with V2 TN were prospectively assigned into the FO group (n = 40) or the FR group (n = 40). All radiofrequency thermocoagulation procedures were performed under the guidance of digital subtraction angiography (DSA). Patients in the FO group were treated with Gasserian ganglion ablation through the Hartel approach. Patients in the FR group received ablation of the maxillary nerve at the internal opening of the FR. Facial pain was evaluated using the Visual Analog Scale preoperatively and postoperatively at 1 week, 6 months, and 1 year. Results: All surgical procedures were successfully completed using DSA guidance. The FR group had no facial pain at postoperative 1 week, 6 months, and 1 year. The facial fain was not relieved in 4 patients of the FO group. They were treated with radiofrequency thermocoagulation of the maxillary nerve through the FR and maintained painless at postoperative 1 week, 6 months, and 1 year. At postoperative 1 year, another 3 patients relapsed in the FO group. The incidences of facial numbness and swelling did not differ significantly between the 2 groups (all P &gt; 0.05). There was no postoperative corneal involvement or masticatory weakness in the FR group. However, corneal involvement and masticatory weakness occurred postoperatively in 22 (55%) patients and 31 (77.5%) patients in the FO group. The FR group had significantly shorter operation time than the FO group (19.3 ± 5.9 vs. 32.7 ± 8.7 minutes; P &lt; 0.05). Limitations: We were unable to avoid the V1 and V3 branches, despite multiple adjustments of the needed position in 35 of the 40 patients in this group. Conclusions: For the treatment of V2 TN, thermocoagulation of the maxillary nerve through the FR had better efficacy and fewer complications in comparison with the Gasserian ganglion ablation through the FO