Evaluation of the Outcome of Different Radio-Frequency Methods (Pulsed, Conventional and Combined) in Treatment of Refractory Typical Trigeminal Neuralgia (Clinical Outcome and Complication Avoidance) in Suez Canal University Hospitals

Document Type : Original Article

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Department of Neurosurgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Abstract

Background: Trigeminal neuralgia (TGN) is a condition characterized by sudden, electric-like or stabbing pain along the distribution of one or more branches of the trigeminal nerve (TN), often triggered by otherwise innocuous stimuli. The combination of pulsed and conventional radiofrequency (RF) techniques has demonstrated promising results in alleviating the pain associated with TGN, reducing the need for medical management, and exhibiting fewer complications compared to the conventional RF method alone. Objectives: to compare the clinical outcomes and complications of pulsed radiofrequency (PRF) to conventional radiofrequency (CRF) to those of combined pulsed and conventional radiofrequency (CCPRF) ablations for the treatment of typical TGN. Study design: it was a randomized clinical trial with simple random sampling of patients with typical TGN. The researchers reviewed hospital databases to identify patients with typical TGN. A total of thirty patients were included, ten in each group. They underwent PRF ablation (pulsed lesioning for 10 minutes at 42°C). CRF ablation (the cut-off needle tip temperature was set at 70°C for 180 seconds), or CCPRF ablation (combined lesion starts by the PRF followed by a conventional lesion of 60°C for 180 seconds) between November 2022 and March 2024.Methods: Exclusion criteria were patients with local infection at the needle puncture site, Maxillofacial fracture, coagulopathy, psychiatric disorders, and history of previous interventions to manage TGN or glycerol injection, patients with multiple sclerosis (MS). The clinical evaluation was by the Barrow Neurological Institute (BNI) scale for pain preoperatively and immediately postoperative and at 3, 6, and 12 months postoperatively, and health-related quality of life scale.Results: The group CCPRF had the best BNI score 12 months postoperatively than the other two groups. The most significant result was between CCPRF and PRF with a P value of 0.004. Most complications per procedure were in the CRF group with 80%. Conclusion: CCPRF results in excellent pain relief and good quality of life for more than 70% of patients at 12 months duration after. CCPRF has fewer complications than CRF ablation, due to the utilization of less temperature for the lesion. PRF has the highest rate of recurrence of the parent’s original pain as before the procedure.

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