Efficacy and safety of combined thermocoagulation radiofrequency and pulse radiofrequency in the treatment of trigeminal neuralgia

Yıl 2023, , 252 - 257, 30.08.2023

Samet Sancar Kaya , Şeref Çelik , Yavuz Akçaboy

https://doi.org/10.47582/jompac.1303163

Cited By: 1

Öz

Aims: The aim of this study was to evaluate the efficacy and safety of radiofrequency thermocoagulation (RFT) combined with pulsed radiofrequency (PRF) of the Gasserian ganglion in patients with V2/V3 trigeminal neuralgia (TN).
Methods: We evaluated 27 patients with V2/3 TN who had undergone combined RFT and PRF of the Gasserian ganglion. Patients were treated with PRF (42°C, 45 V, 20 ms, 120 s), RFT (65°C, 60 s), RFT (70°C, 60 s), and PRF (42°C, 45 V, 20 ms, 120 s), consecutively. Visual analogue scale (VAS) and Barrow Neurological Institute Pain Intensity Scale (BNI) scores were evaluated before and after (1st month, 6th month, and 12th month) the procedure. A BNI score of 1-3 was considered as an effective treatment, while a BNI score of 4 or 5 indicated unsuccessful treatment.
Results: VAS scores were significantly lower than the baseline values in all post-treatment evaluation visits (1st month, 6th month, 12th month) during the 12-month follow-up period (p<0.001). After treatment, 26 patients (96.2%) at 1 month, 25 patients (92.5%) at 6 months, and 20 patients (74%) at 12 months had BNI scores of 1-3. No association was found between improvement in BNI and variables such as age, gender, duration of pain, TN side, affected branch, or pre-treatment VAS scores (p>0.05).
Conclusion: Combined RFT and PRF to the Gasserian ganglion is a safe and effective therapeutic approach in the treatment of TN. However, its efficacy partially decreases after one year.

Anahtar Kelimeler

Trigeminal neuralgia, Gasserian ganglion, pulse radiofrequency, radiofrequency thermocoagulation

V2/3 trigeminal nevraljide termokoagulasyon radyofrekansın pulse radyofrekans ile kombine edilmesinin etkinlik ve güvenliği

Öz

Amaç: V2/V3 trigeminal nevraljide (TN) gasser gangliona radyofrekans termokoagülasyonun (RFT) pulse radyofrekans (PRF) ile kombine olarak uygulanmasının etkililik ve güvenliğini değerlendirmek amaçlandı.
Gereç ve Yöntemler: Gasser gangliona kombine RFT ve PRF tedavisi uygulanmış 27 V2/3 TN'li hasta değerlendirildi. Hastalara sırasıyla PRF (42°C, 45V, 20 ms, 120 saniye), RFT (65 °C, 60 saniye), RFT (70 °C, 60 saniye), PRF (42°C, 45V, 20 ms, 120 saniye) uygulandı. Hastaların işlem öncesi ve sonrası (1.ay, 6. ay, 12. ay) Visual Analog Skala (VAS) ve Barrow Neurolgical Institute Ağrı Yoğunluk Skalası (BNI) skorları değerlendirildi. BNI skorunun 1 ila 3 arasında olması etkili tedavi olarak, BNI skorunun 4 ya da 5 olması ise başarısız tedavi olarak kabul edildi.
Bulgular: VAS skorları, 12 ay izlem dönemince tedavi sonrası tüm değerlendirme sürelerinde (1. ay, 6. ay, 12. ay) başlangıç değerine kıyasla anlamlı olarak daha düşüktü (p<0,001). Tedavi sonrası 1. ayda 26 hasta (% 96,2), 6. ayda 25 (% 92,5) hasta, 12. ayda 20 (%74) hastanın BNI skorları 1-3 arasında idi. BNI'deki iyileşme ile yaş, cinsiyet, ağrı süresi, TN tarafı, etkilenen dal ve işlem öncesi VAS skoru arasında bir ilişki bulunamadı. (p>0,05).
Sonuç: Gasser gangliona uygulanan kombine RFT+PRF TN tedavisinde güvenli ve etkili bir tedavidir. Ancak tedaviden 1 yıl sonra tedavinin etkinliği kısmen azalır.

Anahtar Kelimeler

Trigeminal nevralji, Gasser ganglion, pulse radyofrekans, radyofrekans termokoagülasyon

Kaynakça

• Arnold M. Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia. 2018;38(1):1-211.
• Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348:474.
• Van Hecke O, Austin SK, Khan RA, Smith B, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. PAIN®. 2014;155(4):654-662.
• Bharti N, Sujith J, Singla N, Panda NB, Bala I. Radiofrequency thermoablation of the Gasserian ganglion versus the peripheral branches of the trigeminal nerve for treatment of trigeminal neuralgia: a randomized, control trial. Pain Physician. 2019;22(2):147.
• Van Zundert J, Patijn J, Hartrick C, Lataster A, Huygen F, Mekhail N. Evidence-based interventional pain medicine: according to clinical diagnoses. Pain Pract. 2011;11:423–429.
• Hitchon PW, Holland M, Noeller J, et al. Options in treating trigeminal neuralgia: experience with 195 patients. Clin Neurol Neurosurg. 2016;149:166–170.
• Thapa D, Ahuja V, Dass C, Verma P. Management of refractory trigeminal neuralgia using extended duration pulsed radiofrequency application. Pain Physician. 2015;18:E433-E435.
• Vanneste T, Van Lantschoot A, Van Boxem K, Van Zundert J. Pulsed radiofrequency in chronic pain. Curr Opin Anaesthesiol. 2017;30(5):577-582.
• Sridharan K, Sivaramakrishnan G. Interventions for refractory trigeminal neuralgia: a bayesian mixed treatment comparison network meta-analysis of randomized controlled clinical trials. Clin Drug Investig. 2017;37(9):819-831.
• Fang L, Ying S, Tao W, Lan M, Xiaotong Y, Nan J. 3 D CT‐Guided Pulsed Radiofrequency Treatment for Trigeminal Neuralgia. Pain Pract. 2014;14(1):16-21.
• Fang L, Tao W, Jingjing L, Nan J. Comparison of high‐voltage‐with standard‐voltage pulsed 2015;15(7):595-603.
• Arici T, Kurcaloglu M, Kilic E, Erhan E. Radiofrequency thermocoagulation combined with pulsed radiofrequency for gasserian ganglion blockage. Agri. 2018;30:179-182.
• Ren H, Zhao C, Wang X, Shen Y, Meng L, Luo F. The efficacy and safety of the application of pulsed radiofrequency, combined with low-temperature continuous radiofrequency, to the Gasserian ganglion for the treatment of primary trigeminal neuralgia: study protocol for a prospective, open-label, parall. Pain Physician. 2021;24(1):89.
• Elawamy A, Abdalla EEM, Shehata GA. Effects of pulsed versus conventional versus combined radiofrequency for the treatment of trigeminal neuralgia: a prospective study. Pain Physician. 2017;20(6):E873.
• Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients. Neurosurg. 2001;48(3):524-534.
• Gunduz HB, Cevik OM, Asilturk M, et al. Percutaneous Radiofrequency Thermocoagulation in Trigeminal Neuralgia: Analysis of Early and Late Outcomes of 156 Cases and 209 Interventions. J Korean Neurosurg Soc. 2021;64(5):827-836.
• Zhou X, Liu Y, Yue Z, Luan D, Zhang H, Han J. Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia. Braz J Otorhinolaryngol. 2016;82:574-579.
• Tang Y-Z, Jin D, Bian J-J, Li X-Y, Lai G-H, Ni J-X. Long-term outcome of computed tomography–guided percutaneous radiofrequency Thermocoagulation for classic trigeminal neuralgia patients older than 70 years. J Craniofac Surg. 2014;25(4):1292-1295.
• Wu H, Zhou J, Chen J, Gu Y, Shi L, Ni H. Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. J Pain Res. 2019;12:423.
• Mathews ES, Scrivani SJ. Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia. Mt Sinai J Med. 2000;67(4):288-299.
• Cahana A, Van Zundert J, Macrea L, Van Kleef M, Sluijter M. Pulsed radiofrequency: current clinical and biological literature available. Pain Med. 2006;7(5):411-423.
• Rehman S, Khan M, Hussain R, Jamshed A. Pulsed radiofrequency modulation for lingual neuralgia. Br J Oral Maxillofac Surg. 2012;50(1):e4-e5.
• Cosman Jr ER, Cosman Sr ER. Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med. 2005;6(6):405-424.
• Bogduk N. Pulsed radiofrequency. Pain Med. 2006;7(5):396-407.
• Chua NHL, Halim W, Beems T, Vissers KC. Pulsed radiofrequency treatment for trigeminal neuralgia. Anesth Pain Med. 2012;1(4):257.
• Erdine S, Ozyalcin NS, Cimen A, Celik M, Talu GK, Disci R. Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia. Eur J Pain. 2007;11(3):309-313.
• Ali Eissa AA, Reyad RM, Saleh EG, El-Saman A. The efficacy and safety of combined pulsed and conventional radiofrequency treatment of refractory cases of idiopathic trigeminal neuralgia: a retrospective study. J Anesth. 2015;29(5):728-733.
• Ding Y, Li H, Hong T, Zhu Y, Yao P, Zhou G. Combination of pulsed radiofrequency with continuous radiofrequency thermocoagulation at low temperature improves efficacy and safety in V2/V3 primary trigeminal neuralgia. Pain Physician. 2018;21(5):E545.
• Abdel‐Rahman KA, Elawamy AM, Mostafa MF, et al. Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: a double blinded comparative study. Eur J Pain. 2020;24(2):338-345.
• Tanaka N, Yamaga M, Tateyama S, Uno T, Tsuneyoshi I, Takasaki M. The effect of pulsed radiofrequency current on mechanical allodynia induced with resiniferatoxin in rats. Anesth Analg. 2010;111(3):784-790.
• Zhao W, Wang Q, He M, Yang L, Wu B, Ni J. Radiofrequency thermocoagulation combined with pulsed radiofrequency helps relieve postoperative complications of trigeminal neuralgia. Genet Mol Res. 2015;14(3):7616-7623.