Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: A double blinded comparative study

Abstract

Background: Recurrent trigeminal neuralgia (RTN) is a common clinical problem and pain recurs in many patients after microvascular decompression (MVD). We evaluated the effect of adding pulsed radiofrequency to radiofrequency thermocoagulation at 60°C compared to radiofrequency thermocoagulation at 70°C alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression. Methods: 40 patients with recurrent trigeminal neuralgia after microvascular decompression were randomly divided into two equal groups. Group A: received prolonged duration of pulsed radiofrequency followed by less destructive thermocoagulation, while group B: received sole thermocoagulation. Then patients followed up for 2 years to evaluate the success rate by the Barrow Neurological Institute Pain Intensity (BNI) Scale, complications, and the need to medical treatment. Results: The success rate was 100% in both groups at discharge (BNI < III). It was 83.3% and 78.7% after 6 months, 77.8% and 68.4% after 12 month, 72.2% and 68.4% after 18 months and 66.7% and 63.1% after 24 months in group A and B, respectively (p > .05). In group A 88.9% of patients stopped tegretol treatment after the procedure compared to 84.2% in group B (p = .32). 88.9% compared to 89.5% % in group A and B, respectively, did not use tricyclic antidepressant (p = .61). The overall complications in group A was 5.61%, while it was 36.8% in group B (p = .025). Conclusion: Combined pulsed and thermal radiofrequency can significantly reduce the incidence of the side effects/complications with similar success rate than using thermal radiofrequency alone in treatment of recurrent trigeminal neuralgia after microvascular decompression. | 339 ABDEL-RAHMAN Et AL. How to cite this article: 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;24:338-345. https ://doi.

Treatment of redo-microvascular decompression or internal neurolysis plus microvascular decompression for recurrent trigeminal neuralgia: a review of long-term effectiveness and safety

“…17 Compared with percutaneous balloon compression, stereotactic radiosurgery, and radiofrequency thermocoagulation, all of which are associated with a high likelihood of recurrence and sensory deficits, redo-MVD reportedly has good outcomes in the management of recurrent TN. [18][19][20] Recurrence in 64 of 137 patients in this study was due to incomplete or absent decompression or new responsible vessels. To ensure thorough pain relief, redo-MVD should include decompression of both the trigeminal root entry zone and the peripheral nerve segments, where blood vessels can cause symptoms.…”

“… 17 Compared with percutaneous balloon compression, stereotactic radiosurgery, and radiofrequency thermocoagulation, all of which are associated with a high likelihood of recurrence and sensory deficits, redo-MVD reportedly has good outcomes in the management of recurrent TN. 18 – 20 …”

Trigeminal Neuralgia: Current Approaches and Emerging Interventions

“…Rarely, CSF leak, carotid-cavernous fistula, meningitis, and anesthesia dolorosa/trigeminal deafferentation pain may be encountered. 120,[166][167][168][169][170][171][172][173][174][175][176][177][178][179][180]…”

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, Parallel, Randomized Controlled Trial

“…The patients will be assigned to either of the following groups, determined by the envelopes opened by the study nurse. Two hertz of PRF will be administered at a voltage of 70 V, temperature of 42°C, pulse width of 20 ms, and treatment time of 600 s. (29,31) Then low-temperature CRF will be performed at 60°C, with a treatment time of 270 s (31,33).…”

“…In a retrospective study, PRF combined with CRF at 68°C was more effective than CRF alone (97.5% vs. 87.5%) after 1 year, along with fewer side effects and faster recovery times (32). The most recent randomized controlled trial found that PRF, combined with CRF at 60°C, for the treatment of recurrent trigeminal neuralgia after microvascular decompression, resulted in fewer side effects and complications with a similar effectiveness to CRF at 70°C (33). Currently, there is no consensus on the treatment parameters for PRF combined with CRF; including treatment time, temperature, and voltage.…”