Comparison of High‐voltage‐ with Standard‐voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia

Abstract

Although pulsed radiofrequency treatment (PRFT) has been used to treat trigeminal neuralgia (TN) safely, satisfactory improvement is lacking. Recently, much attention has been paid to the PRFT dose and intra-operative parameters. It has been reported that high-voltage PRFT could significantly reduce discogenic pain. However, there is no study investigating the effects of high-voltage PRFT on TN. The aim of this prospective, randomized, double-blinded study was to evaluate the efficacy and safety of high-voltage PRFT in comparison with standard-voltage PRFT for idiopathic TN. Sixty severe TN patients were randomly assigned to 2 groups treated with CT-guided standard- or high-voltage-pulsed radiofrequency (RF) of Gasserian ganglion, respectively, between January 2012 and July 2012. Numeric Rating Scales (NRS), carbamazepine dose, and side effects were evaluated at day 1, weeks 1 and 2, months 1, 3, and 6, and 1 year postoperative. There were 27 patients in the standard-voltage group and 26 patients in the high-voltage group who completed the 1-year follow-up study. The effective rates in the standard-voltage and high-voltage PRFT groups were 41% and 69%, respectively, at 1, 3, and 6 months postoperative (P = 0.037). The effective rate in the standard-voltage group decreased to 19% at 1-year postoperative, while in the high-voltage group remained at 69% (P = 0.000). No significant side effects were detected in both groups. In conclusion, CT-guided high-voltage PRFT is an effective and safe interventional therapeutic choice for idiopathic TN patients.

Treatment of Refractory Idiopathic Supraorbital Neuralgia Using Percutaneous Pulsed Radiofrequency

“…Therefore, the study results could only suggest that PRF might have treatment effects on idiopathic supraorbital neuralgia patients. Consistent with previous treatment of trigeminal neuralgia or extracranial neuralgia of the trigeminal nerve using PRF, 8,11,14 treatment of supraorbital neuralgia using PRF did not immediately achieve satisfactory efficacy; the possible cause was the time course for effect of PRF. In this study, the average response time of approximately 7 days showed that PRF could take some time for full effect.…”

“…Several recent studies have noted that the PRF treatment of the Gasserian ganglion is a minimally invasive, safe, and effective interventional treatment choice for trigeminal neuralgia patients. [7][8][9][10] Several recent reports have shown that treatment of extracranial neuralgia of the trigeminal nerve, including PRF treatment of the infraorbital nerve and mental nerve, could significantly improve the symptoms of neuralgia. [11][12][13][14] However, evidence for the treatment of supraorbital neuralgia using PRF is very limited.…”

The Long-Term Outcome of CT-Guided Pulsed Radiofrequency in the Treatment of Idiopathic Glossopharyngeal Neuralgia: a preliminary multi-center case series

“…In our previous study, we found that the efficacy of PRF treatment was positively correlated with the output voltage [35]. Subsequently, prospective, randomized, double-blinded studies have certified that high-voltage PRF is more effective than standard-voltage in treating idiopathic TN and refractory infraorbital neuralgia [33,36]. However, there is a lack of research evaluating the effectiveness and safety of high-voltage PRF on the treatment of idiopathic GPN patients.…”

High Voltage Pulsed Radiofrequency for the Treatment of Refractory Neuralgia of the Infraorbital Nerve: A Prospective Double-Blinded Randomized Controlled Study

“…In 2015, a randomized controlled study showed that high voltage PRF of Gasserian ganglion significantly improved the treatment outcomes relative to standard voltage PRF in patients with trigeminal neuralgia (9). However, whether increasing the output voltage of PRF can improve the treatment outcomes of neuralgia of the infraorbital nerve is unknown.…”

“…For the standard voltage group, the automatic PRF mode was used (standard parameters: 42 o , 2 Hz, 120 s, 2 times). For the high voltage group, the manual PRF mode was used (maximum temperature: 42 o ; the UP knob was turned to increase the output voltage until the maximum voltage [bearable without causing pain in conscious patients] was reached; 120 s, 2 times) (9). At one month after treatment, patients who did not respond to the PRF received RFTC; the same puncture procedure was performed, and the RFTC mode was used (…”