Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis

Computer simulation of low-power and long-duration bipolar radiofrequency ablation under various baseline impedances

Compared to traditional unipolar radiofrequency ablation (RFA), bipolar RFA offers advantages such as more precise heat transfer and higher ablation efficiency. Clinically, myocardial baseline impedance (BI) is one of the important factors affecting the effectiveness of ablation. We aim at finding suitable ablation protocols and coping strategies by analyzing the ablation effects and myocardial impedance changes of bipolar RFA under different BIs. In this research, a three-dimensional local myocardial computer model was constructed for bipolar RFA simulation, and in vitro experimental data were used to validate accuracy. Four fixed low-power levels (20 W, 25 W, 30 W, and 35 W) and six myocardial BIs (91.02 Ω, 99.83 Ω, 111.03 Ω, 119.77 Ω, 130.03 Ω, and 135.45 Ω) were set as initial conditions, with an ablation duration of 120-s. In the context of low-power and long-duration (LPLD) ablation, the maximum TID (TIDM) decreased by 21-32 Ω, depending on the BI. In cases where steam pop did not occur, TIDM increased with the increase in power. For the same power, there was no significant difference in TIDM for the range of BIs. In cases where steam pop occurred, for every 1 Ω increase in BI, TIDM increased by 0.34-0.41 Ω. The simulation results also showed that using a higher power resulted in a smaller decrease in TIDM. This study provided appropriate ablation times and impedance decrease ranges for bipolar LPLD RFA. The combination of 25 W for 120-s offered optimal performance when considering effectiveness and safety simultaneously.

Modern Approaches to the Treatment of Acute Facial Pain

PURPOSE OF REVIEW

Acute facial pain presents a complex challenge in medical practice, requiring a comprehensive and interdisciplinary approach to its management. This narrative review explores the contemporary landscape of treating acute facial pain, delving into pharmacological, non-pharmacological, and advanced interventions. The significance of tailored treatment strategies, rooted in the diverse etiologies of facial pain, such as dental infections, trigeminal neuralgia, temporomandibular joint disorders, sinusitis, or neurological conditions like migraines or cluster headaches, is underscored. We particularly emphasize recent advances in treating trigeminal neuralgia, elucidating current treatment concepts in managing this particular acute facial pain.

RECENT FINDINGS

Recent research sheds light on various treatment modalities for acute facial pain. Pharmacotherapy ranges from traditional NSAIDs and analgesics to anticonvulsants and antidepressants. Non-pharmacological interventions, including physical therapy and psychological approaches, play pivotal roles. Advanced interventions, such as nerve blocks and surgical procedures, are considered in cases of treatment resistance. Moreover, we explore innovative technologies like neuromodulation techniques and personalized medicine, offering promising avenues for optimizing treatment outcomes in acute facial pain management. Modern management of acute facial pain requires a nuanced and patient-centric approach. Tailoring treatment strategies to the individual's underlying condition is paramount. While pharmacotherapy remains a cornerstone, the integration of non-pharmacological interventions is essential for comprehensive care. Advanced interventions should be reserved for cases where conservative measures prove inadequate. Furthermore, leveraging innovative technologies and personalized medicine holds promise for enhancing treatment efficacy. Ultimately, a holistic approach that considers the diverse needs of patients is crucial for effectively addressing acute facial pain.

Personalized 3D Printed Tooth-Supported Template as a Novel Strategy for Radiofrequency Thermocoagulation for Trigeminal Neuralgia After the Failure of CT-Guided Puncture

Background

Trigeminal neuralgia (TN) is a common form of craniofacial pain, and Radiofrequency thermocoagulation (RFT) has become a commonly utilized treatment modality for TN. However, the complex anatomical configuration of the maxillofacial region and the difficulties inherent in positioning the neck in a hyperextended manner can present challenges for CT-guided punctures.

Aim

The objective of this study is to assess the effectiveness and safety of 3D printed tooth-supported template(3D-PTST) guided RFT in patients who have previously undergone unsuccessful CT-guided puncture.

Methods

Patients with TN undergoing RFT at the Department of Pain Medicine, PLA General Hospital, from January 2018 to January 2023, were assessed. 3D-PTST guided RFT was employed as an alternative when percutaneous puncture failed. Clinical, demographic, and follow-up data were collected. The duration of the procedure was determined by subtracting the time of anesthesia administration from the time of surgical drape removal. Pain intensity was assessed using the Numerical Rating Scale-11 scale. Treatment effects were evaluated utilizing the Barrow Neurological Institute scale. Incidences of complications related to RFA were documented.

Results

Six TN patients underwent 3D-PTST guided RFT. With tooth-supported template guidance, five patients achieved therapeutic target puncture in one attempt with one CT scan. One patient required two attempts with two CT scans. Operation duration ranged from 18 to 46 mins (mean 30 mins). All completed 3D-PTST-guided RFT without difficulty, significantly improving pain symptoms. Four patients had no pain recurrence at 12, 18, 36 and 37 months follow-up, respectively. Recurrence occurred in two patients (at 1 and 13 months). No serious treatment-related complications were observed.

Conclusion

3D-PTST guided RFT is an effective, repeatable, safe, and minimally invasive treatment method for patients with TN who have failed due to difficulty in puncture.

Percutaneous Continuous Radiofrequency Versus Pulsed Radiofrequency Thermorhizotomy for the Treatment of Neuralgia of the Trigeminal Nerve: A Retrospective Observational Study

OBJECTIVES

Trigeminal neuralgia (TN) represents one of the most powerful manifestations of neuropathic pain. The diagnostic criteria, as well as its therapeutic modalities, stand firmly established. The percutaneous radiofrequency thermorhizotomy of the gasserian ganglion and posterior root of the trigeminal nerve stands as a widely employed procedure in this context. In this retrospective observational investigation, we undertake a comparative analysis of patients subjected to treatment employing continuous radiofrequency (C-rF) versus pulsed radiofrequency (P-rF).

MATERIALS AND METHODS

A cohort of 128 patients afflicted with essential neuralgia of the trigeminal nerve, all under the care of the distinguished author (JCA), underwent percutaneous radiofrequency thermorhizotomy between the years 2005 and 2022. They were stratified into two cohorts: Group 1 encompassed 76 patients treated with C-rF, while Group 2 comprised 52 patients subjected to P-rF intervention. All participants met the stringent inclusion and exclusion criteria for TN, with a notable concentration in the V2 and V3 territories accounting for 60% and 45%, respectively. The post-procedural follow-up period exhibited uniformity, spanning from six months to 16 years. Preceding the intervention, all patients uniformly reported a visual analog scale (VAS) score surpassing 6/10. Additionally, everyone had been undergoing pharmacological management, involving a combination of antineuropathic agents and low-potency opioids.

RESULTS

The evaluation of clinical improvement was conducted across three temporal domains: the immediate short-term (less than 30 days), the intermediate-term (less than one year), and the prolonged-term (exceeding one year). In the short term, a noteworthy alleviation of pain, surpassing the 50% threshold, was evident in most patients (94%), a similarity observed in both cohorts (98% in Group 1 and 90% in Group 2). The VAS revealed an average rating of 3/10 for Group 1 and 2/10 for Group 2. Moving to the intermediate term, more than 50% improvement in pain was registered in 89% of patients (92% in Group 1 and 86% in Group 2). The mean VAS score stood at 3.5/10, marginally higher in Group 2 at 4/10 compared to 3/10 in Group 1. In the final assessment, a 50% or greater reduction in pain was reported by 75% of patients, with no discernible disparity between the two cohorts. Among the cohort, 18 individuals necessitated a subsequent percutaneous intervention (10 in Group 1 and eight in Group 2), while microvascular decompression was performed on six patients (equitably distributed between the two groups), and radiosurgery was administered to three patients in Group 1.

CONCLUSIONS

Percutaneous radiofrequency thermorhizotomy emerges as an efficacious modality for addressing essential TN. The employment of continuous radiofrequency yields superior long-term outcomes, albeit accompanied by sensitive manifestations that may prove discomforting. Pulsed radiofrequency demonstrates commendable clinical efficacy with a diminished incidence of complications, rendering it a viable option even for other manifestations of facial pain.

The CSF1-CSF1R pathway in the trigeminal ganglion mediates trigeminal neuralgia via inflammatory responses in mice

BACKGROUND

Trigeminal neuralgia (TN) is the most severe type of neuropathic pain. The trigeminal ganglion (TG) is a crucial target for the pathogenesis and treatment of TN. The colony-stimulating factor 1 (CSF1) - colony-stimulating factor 1 receptor (CSF1R) pathway regulates lower limb pain development. However, the effect and mechanism of the CSF1-CSF1R pathway in TG on TN are unclear.

METHODS

Partial transection of the infraorbital nerve (pT-ION) model was used to generate a mouse TN model. Mechanical and cold allodynia were used to measure pain behaviors. Pro-inflammatory factors (IL-6, TNF-a) were used to measure inflammatory responses in TG. PLX3397, an inhibitor of CSF1R, was applied to inhibit the CSF1-CSF1R pathway in TG. This pathway was activated in naïve mice by stereotactic injection of CSF1 into the TG.

RESULTS

The TN model activated the CSF1-CSF1R pathway in the TG, leading to exacerbated mechanical and cold allodynia. TN activated inflammatory responses in the TG manifested as a significant increase in IL-6 and TNF-a levels. After using PLX3397 to inhibit CSF1R, CSF1R expression in the TG declined significantly. Inhibiting the CSF1-CSF1R pathway in the TG downregulated the expression of IL-6 and TNF-α to reduce allodynia-related behaviors. Finally, mechanical allodynia behaviors were exacerbated in naïve mice after activating the CSF1-CSF1R pathway in the TG.

CONCLUSIONS

The CSF1-CSF1R pathway in the TG modulates TN by regulating neuroimmune responses. Our findings provide a theoretical basis for the development of treatments for TN in the TG.

The Role of Radiofrequency Ablation in the Treatment of Trigeminal Neuralgia: A Narrative Review

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, the largest of the cranial nerves. It is characterized by severe, sudden, and recurrent facial pain, often triggered by light touch or a breeze. Treatment options for TN include medication, nerve blocks, and surgery, but radiofrequency ablation (RFA) has emerged as a promising alternative. RFA is a minimally invasive procedure that uses heat energy to destroy the small portion of the trigeminal nerve responsible for the pain. The procedure is performed under local anesthesia and can be done as an outpatient procedure. RFA has been shown to provide long-term pain relief for TN patients with a low complication rate. However, RFA is not suitable for all TN patients and may not be effective for those with multiple pain sites. Despite these limitations, RFA is a valuable option for TN patients who are not responding to other treatments. Furthermore, RFA is a good alternative for a patient unsuitable for surgery. Further research is needed to fully understand the long-term effectiveness of RFA and identify the best candidates for the procedure.

Puncture approaches and guidance techniques of radiofrequency thermocoagulation through foramen Ovale for primary trigeminal neuralgia: Systematic review and meta-analysis

Objective

Trigeminal neuralgia (TN) is one of the leading causes of facial pain and seriously affects patients' quality of life. Foramen ovale (FO) radiofrequency thermocoagulation is a classic approach for the treatment of TN that has failed pharmacological therapy. This study summarized the safety and efficacy of transforaminal radiofrequency thermocoagulation for TN by comparing puncture approaches or guidance techniques, thereby providing higher-quality clinical evidence.

Methods

Databases including PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched for relevant studies published before May 2022. Relevant data were extracted for analysis to compare methodological variables and clinical outcomes.

Results

This meta-analysis included 27 studies with a total of 1,897 patients. In terms of puncture approaches, FO had a significant advantage in reducing VAS at 12 months postoperatively (P = 0.019) and efficacy (P = 0.043). However, FO performed poorly on complications (P < 0.001), operation time (P < 0.001), and the number of needle adjustments (P < 0.001). Regarding the guidance techniques, the adjunctive use of guidance techniques could reduce patients' 6-month VAS (P < 0.001) and 12-month VAS (P < 0.001), improve the efficacy (P = 0.032), reduce recurrence rates (P = 0.001), shorten operation times (P < 0.001), decrease times of intraoperative fluoroscopy (P < 0.001), and improve the success of the first puncture (P < 0.001).

Conclusion

FO radiofrequency thermocoagulation has advantages in efficacy it can still better relieve the pain of patients 12 months postoperatively. However, FO has disadvantages in complications, recurrences, and operation time. The adjunctive use of guidance techniques has a positive effect on treatment efficacy and safety during FO radiofrequency thermocoagulation. However, the results still require large samples and high-quality randomized clinical trials to confirm.

Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia With Multiple Sclerosis: A Rare Clinical Case

In rare instances, the extremely painful disorder trigeminal neuralgia (TN) may develop as a result of multiple sclerosis (MS). In this article, we will be discussing the case of a 56-year-old female with TN. Antidepressants and analgesics can lessen the pain, although they were not very effective, and higher doses led to greater drowsiness and a poorer quality of life. Radiofrequency ablation helped this patient significantly lower the pain and led to an improved lifestyle. This case presents right-side radiofrequency ablation of Gasserian ganglion in a patient with unilateral TN with MS.

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 messagesThis 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.

Circ TYMP1 Inhibits Carcinogenesis and Cisplatin Resistance in Ovarian Cancer by Reducing Smad2/3 Phosphorylation via a MicroRNA-182A-3p/TGF1B Axis

TYMP1 is a cancer driver in several human malignancies. However, its significance in ovarian cancer (ovarian carcinoma) remains uncertain. This research aims to understand the TYMP1's role in ovarian carcinoma carcinogenesis and cisplatin (DDP) resistance and its molecular ovarian marchionesses. Circ TYMP1 overexpression in ovarian carcinoma samples led to an accelerated tumor stage. Bioinformatics identified miR-182A-3p as the TYMP1's target transcript. Circ TYMP1 functioned as a sponge for miR-182A-3p, lowering its inhibitory effect on TGF1B. Downregulating circ TYMP1 decreased A2780-Res cell proliferation, invasion, and death resistance. Malignant ovarian carcinoma cells recovered following miR-182A-3p downregulation. TGF1B overexpression boosted A2780-Res cell proliferation, aggression, and cisplatin resistance while reducing Smad2/3 phosphorylation. TYMP1 sequesters miR-182A-3p and promotes TGF1B in ovarian carcinoma, boosting carcinogenesis and cisplatin resistance. This might lead to novel ovarian carcinoma treatments.

Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain

BACKGROUND

Cervical facet joint pain (CFP) is one of the most common causes of neck pain and headache. Persistent CFP deteriorates the quality of life of patients and reduces their productivity at work.

AIM

To investigate the effectiveness of pulsed radiofrequency (PRF) stimulation of cervical medial branches in patients with chronic CFP.

METHODS

We retrospectively included 21 consecutive patients (age = 50.9 ± 15.3 years, range 26-79 years; male: female = 8:13; pain duration = 7.7 ± 5.0 mo) with chronic CFP, defined as ≥ 4 on the numeric rating scale (NRS). We performed PRF stimulation on the cervical medial branches. The outcomes of the PRF procedure were evaluated by comparing the NRS scores for CFP before treatment and 1 and 3 mo after treatment. Successful pain relief was defined as a ≥ 50% reduction in the NRS score at 3 mo when compared with the pretreatment NRS score.

RESULTS

No patient had immediate or late adverse effects following PRF. The average NRS score for CFP decreased from 5.3 ± 1.1 at pre-treatment to 2.4 ± 0.6 at the 1 mo follow-up, and 3.1 ± 1.1 at the 3 mo follow-up. Compared to the NRS scores before PRF stimulation, those at 1 and 3 mo after PRF stimulation had significantly decreased. Eleven of the 21 patients (52.4%) reported successful pain relief 3 mo after the PRF procedure. PRF stimulation on cervical medial branches may be a useful therapeutic option to control chronic CFP.

CONCLUSION

PRF stimulation of the cervical medial branches may be used as an alternative treatment method in patients with CFP. PRF can effectively alleviate CFP, and is safe to perform.

Efficacy and safety of high-voltage versus standard-voltage pulsed radiofrequency ablation for patients with neuropathic pain: protocol for a systematic review and meta-analysis

INTRODUCTION

Pulsed radiofrequency (PRF) ablation is commonly used for the treatment of neuropathic pain (NP). However, it is unclear whether increasing the output voltage of PRF can safely improve its efficacy. This study aims to compare the efficacy and safety of high-voltage PRF ablation and standard-voltage PRF ablation for the treatment of patients with NP.

METHODS AND ANALYSIS

We will search PubMed/MEDLINE, EMBASE, Web of Science, the Cochrane Library, conference proceedings for relevant abstracts, clinical trials registers (ClinicalTrials.gov) and the WHO's International Clinical Trial Registry Platform (from the date of inception until 15 March 2022). Only randomised controlled trials will be included. Two reviewers (YJ and GF) will independently perform study screening and selection, data extraction, risk-of-bias assessment and quality-of-evidence assessment. The primary outcome of this meta-analysis will be the efficiency rate in patients with NP. The secondary outcomes will include numeric rating scale score, visual analogue scale score, time to take effect, rescue drug dosage, quality of life using the health questionnaire (SF-36) and the incidence of adverse events. Meta-analyses will be conducted using standard meta-analysis software (RevMan V.5.3, The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark).

ETHICS AND DISSEMINATION

The requirement for ethical approval was waived as our systematic review will be based on the published literature. The results of this study will be submitted to a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022297804.

Radiofrequency thermocoagulation for the treatment of trigeminal neuralgia

Although microvascular decompression (MVD) should be considered as the first-line treatment for classic trigeminal neuralgia (TN) owing to neurovascular compression of the trigeminal nerve, an increasing number of surgeons prefer radiofrequency thermocoagulation (RFT). RFT is a Gasserian ganglion-level ablative intervention that may achieve immediate pain relief for TN. It is used for emergency management when MVD is not suitable for the patient. As the gold surgical standard of classic trigeminal neuralgia, MVD has the advantage of longer efficacy. However, there are currently no high-quality controlled trials to evaluate the efficacy of MVD and RFT. For the present systematic review, the PubMed, Embase and Cochrane databases (all entries up until July 31, 2020) were searched to identify studies related to RFT in order to provide valuable information for clinical decision-making. The efficacy of the RFT method was evaluated in terms of the initial pain relief percentage, recurrence rate and follow-up time. Furthermore, the incidence rate of various postoperative complications was retrieved. RFT was used for a wider range of applications than MVD, including use for primary (owing to neurovascular compression of the trigeminal nerve), idiopathic and secondary (due to primary neurological diseases) TN, and provided a high rate of initial pain relief and long-term pain control. Although this method has several side effects, the incidence of complications could be reduced by precise cannulation. Furthermore, the complications that occurred were not permanent. Thus, RFT is a safe and effective minimally invasive method of pain relief for patients with TN.

Inhibitory Effects of Palmatine on P2X7 Receptor Expression in Trigeminal Ganglion and Facial Pain in Trigeminal Neuralgia Rats

Trigeminal Neuralgia (TN) refers to recurrent severe paroxysmal pain in the distribution area of the trigeminal nerve, which seriously affects the quality of life of patients. This research applied the chronic constriction injury of the infraorbital nerve (CCI—ION) approach to induce an animal model of TN in rats. The mechanical pain threshold of each group of rats was determined postoperatively; the expression of P2X7 receptor in trigeminal ganglion (TG) was assessed by qRT-PCR, immunofluorescence and Western blot; and the changes of the proinflammatory cytokines IL-1β and TNF-α in serum of rats were detected by ELISA. The results showed that the administration of palmatine in the TN rats could reduce the mechanical pain threshold, significantly decrease the expression of P2X7 receptor in TG, and lower the serum concentrations of IL-1β and TNF-α, compared to the sham group. In addition, the phosphorylation level of p38 in TG of TN rats was significantly decreased after treatment with palmatine. Likewise, inhibition of P2X7 expression by shRNA treatment could effectively counteract the adversary changes of pain sensitivity, IL-1β and TNF-α production, and p38 phosphorylation in TN rats. Our data suggest that palmatine may alleviate mechanical facial pain in TN rats possibly by reducing the expression of P2X7 receptor in TG of TN rats, which may be attributable to inhibiting p38 phosphorylation and reducing the release of IL-1β and TNF-α.

[A comparative analysis of clinical efficiency of laser and radiofrequency denervation in patients with primary trigeminal neuralgia]

OBJECTIVE

To compare the clinical efficacy of laser and radiofrequency denervation in patients with primary trigeminal neuralgia.

MATERIAL AND METHODS

The study included 50 patients with primary trigeminal neuralgia who were operated on by laser (group I, n=25) or radiofrequency denervation (group II, n=25) in the period from 2018 to 2019. To assess the clinical efficacy, we analyzed the dynamics of the pain syndrome level according to the scale of facial pain and the quality of life according to the Short Form Medical Outcomes Study (SF-36), as well as patient satisfaction with the operation according to the Macnab scale, the presence of postoperative surgical complications and adverse effects of anesthesia.

RESULTS

In the postoperative period, according to the scale of facial pain, a decrease in its intensity was noted in both study groups (p<0.001). Comparative analysis showed a comparable level of pain in the early postoperative period: at discharge (p=0.43) and 6 months after surgery (p=0.07). At the same time, after 12 months, lower scores on the scale of facial pain were noted in patients of group I (p=0.02). According to SF-36, a significant improvement in the physical and psychological components of health was determined in group I (p<0.001) and group II (p<0.05). Comparison of SF-36 scores in the long-term postoperative period revealed the best indicators in group I (p=0.02 and p=0.01, respectively). Comparative analysis verified a greater subjective satisfaction with the operation in group I, compared with group II (p<0.001). A comparable number of adverse effects of anesthesia was determined in both groups. Comparative analysis revealed a significantly greater number of postoperative surgical complications in group II (p=0.0017).

CONCLUSION

Laser denervation and radiofrequency denervation are highly effective methods of minimally invasive treatment of primary trigeminal neuralgia.

Masticatory Dysfunction After Computed Tomography-Guided Plasma Ablation vs. Radiofrequency Ablation on Gasserian Ganglion for Idiopathic Trigeminal Neuralgia: A Randomized Controlled Trial

OBJECTIVE

We aimed to evaluate masticatory dysfunction after two different types of ablation on the Gasserian ganglion for the treatment of idiopathic trigeminal neuralgia. We hypothesized that low-temperature plasma radiofrequency ablation (LTP-RFA) was noninferior to radiofrequency thermocoagulation (RFT) with respect to initial efficacy.

METHODS

In the randomized, single-blind, parallel-group, noninferiority trial, 204 participants with idiopathic trigeminal neuralgia were randomly allocated to receive plasma ablation in the LTP-RFA group and radiofrequency ablation in the RFT group in a 1:1 ratio, with random block sizes of four or six. Participants were examined at baseline (T0), on the day of discharge (T1), and at the 6-month follow-up (T2). The primary end point was the clinincal effective rate in the LTP-RFA group compared with that in the RFT group after intervention on the day of discharge. Noninferiority was prespecified at -10%.

RESULTS

The intention-to-treat analysis revealed that the initial efficacy rates were 91.2% in LTP-RFA group and 93.1% in RFT group (rate ratio [RR] = 0.979, 95% confidence interval [CI]: 0.904-1.061, P = 0.795). The difference between the two groups was 1.9% (95% CI: -5.6% to 9.4%), which showed that LTP-RFA demonstrated noninferiority compared with RFT in initial efficacy. Compared with the RFT group, the LTP-RFA group exhibited a significantly greater improvement in the maximum voltage of the masseter muscles with mean differences of 11.40 (95% CI: 10.52 to 12.27, P < 0.001) at T1 and 17.41 (95% CI: 14.68 to 20.13, P < 0.001) at T2, respectively. Similar results were observed for the asymmetry index of occlusion, the maximum voltage of the anterior temporalis, and the activity index of anterior temporalis / masseter muscles. No serious adverse events were observed in either group.

CONCLUSIONS

Compared with the RFT group, noninferior efficacy for pain relief and improvement of masticatory function was revealed in the LTP-RFA group.

Craniofacial neuralgias

While non-headache, non-oral craniofacial neuralgia is relatively rare in incidence and prevalence, it can result in debilitating pain. Understanding the relevant anatomy of peripheral branches of nerves, natural history, clinical presentation, and management strategies will help the clinician better diagnose and treat craniofacial neuralgias. This article will review the nerves responsible for neuropathic pain in periorbital, periauricular, and occipital regions, distinct from idiopathic trigeminal neuralgia. The infratrochlear, supratrochlear, supraorbital, lacrimal, and infraorbital nerves mediate periorbital neuralgia. Periauricular neuralgia may involve the auriculotemporal nerve, the great auricular nerve, and the nervus intermedius. The greater occipital nerve, lesser occipital nerve, and third occipital nerve transmit occipital neuralgias. A wide range of treatment options exist, from modalities to surgery, and the evidence behind each is reviewed.

Percutaneous imaging-guided techniques for the treatment of benign neuropathic pain

To date, conservative management including physical and/or systemic pharmacologic therapy is considered as the first line approach for the management of neuropathic pain syndromes. In the era of an opioid overdose crisis with an increased concern upon the risks and harms arising from the misuse of medicines for pain management, percutaneous minimally invasive techniques such as nerve infiltrations as well as neurolysis or neuromodulation techniques can be proposed to control pain and improve life quality. Computed tomography can serve as an ideal guiding technique due to its specific characteristics including precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to make the reader familiar with the most common indications for minimally invasive imaging-guided techniques in patients with neuralgia and provide current evidence regarding technical considerations.

Effects of Supraorbital Foramen Variations on the Treatment Efficacy of Radiofrequency Therapy for V1 Trigeminal Neuralgia: A Retrospective Study

Background

Primary V1 trigeminal neuralgia is a common refractory neuralgia in clinical practice, lacking effective treatments. Radiofrequency therapy has certain treatment efficacy, but its long-term efficacy remained poor and the disease might relapse.

Objective

To compare the effects of different types of supraorbital foramen variations on the treatment efficacy of radiofrequency therapy for V1 trigeminal neuralgia.

Methods

Data of 54 patients with V1 trigeminal neuralgia who underwent treatment in the First Hospital of Jiaxing, Zhejiang, were retrospectively analyzed. All these patients received CT-guided radiofrequency thermocoagulation of supraorbital nerve. According to the CT images, the supraorbital foramen of the patients was categorized as holes (hole group) or notches (notch group). The patient characteristics, including Numerical Rating Scale (NRS) score and effective treatment rates before and 1 d, 0.5 y, 1 y, and 2 y after operation, and numbness degree at day 1 and 2 y after the operation were compared. The short- and long-term complications during postoperative follow-up period were also recorded.

Results

Among the 54 patients, 25 patients were grouped into the hole group and 29 into the notch group. The NRS scores before and at 1 d, 0.5 y, 1 y, and 2 y after operation showed no significant differences between the two groups. However, the NRS scores at the remaining time points after operation were significantly decreased when compared with scores before operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (

Conclusion

The short- and long-term effective rates of radiofrequency therapy during V1 trigeminal neuralgia treatment are relatively high in patients with different types of supraorbital foramen variations. However, the effective rate is even higher in patients with hole-type supraorbital foramen. No other severe complications, except numbness, were found, and the acceptability rate remained high in patients.