Comparative Analysis of Balloon Compression and Radiofrequency Ablation in Idiopathic Trigeminal Neuralgia: A Retrospective Study with a 24-Month Follow-up

Abstract Objective The purpose of this study is to evaluate the effectiveness and safety of percutaneous radiofrequency thermocoagulation (PRT) via the foramen rotundum (FR) for the treatment of isolated maxillary (V2) idiopathic trigeminal neuralgia (ITN) and assess the appropriate puncture angle through the anterior coronoid process to reach the FR. Methods Between January 2011 and October 2016, 87 patients with V2 ITN refractory to conservative treatment were treated by computed tomography (CT)–guided PRT via the FR at our institution. The outcome of pain relief was assessed by the visual analog scale (VAS) and Barrow Neurological Institute (BNI) pain grade and grouped as complete pain relief (BNI grades I–III) or unsuccessful pain relief (BNI grades IV–V). Recurrence and complications were also monitored and recorded. The puncture angle for this novel approach was assessed based on intraoperative CT images. Results Of the 87 treated patients, 85 (97.7%) achieved complete pain relief, and two patients (2.3%) experienced unsuccessful pain relief immediately after operation. During the mean follow-up period of 44.3 months, 15 patients (17.2%) experienced recurring pain. No severe complications occurred, except for hypoesthesia restricted to the V2 distribution in all patients (100%) and facial hematoma in 10 patients (11.5%). The mean puncture angle to reach the FR was 33.6° ± 5.7° toward the sagittal plane. Discussion CT-guided PRT via the FR for refractory isolated V2 ITN is effective and safe and could be a rational therapy for patients with V2 ITN.

Download Full-text

TM2-4 Long term outcome of percutaneous balloon compression for trigeminal neuralgia

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.42 ◽

2019 ◽

Vol 90 (3) ◽

pp. e13.3-e12 ◽

Cited By ~ 1

Author(s):

D Bhargava ◽

P Cristaldi ◽

P Franceschini ◽

P Eldridge ◽

J Osman-Farah

Keyword(s):

Trigeminal Neuralgia ◽

Symptom Relief ◽

Term Outcome ◽

Long Term Outcome ◽

Balloon Compression ◽

Percutaneous Balloon ◽

Retrospective Audit ◽

Percutaneous Balloon Compression ◽

Anaesthesia Dolorosa

ObjectivesPercutaneous balloon compression (PBC) can be offered to medically refractory patients with trigeminal neuralgia who are unsuitable for microvascular decompression. Its associated with up to 4% risk of anaesthesia dolorosa which increases with duration and severity of compression and is more common with repeat procedures. We audited our outcomes for this procedure over last 7 years.DesignRetrospective audit of prospectively collected data.SubjectsAll patients undergoing PBC at our centre.MethodsTheatre and radiology records reviewed to identify patients. Case notes and radiology reviewed for history, diagnosis, details of procedure, immediate symptom relief, complications, further procedures and last follow up. Descriptive, comparative Kaplan Meir analysis undertaken.ResultsTotal 93 patients (4 b/l), 165 procedures. Average follow up 36 months. 24 patients had MS, 17 patients had atypical pain. All except 4 patients had good immediate pain relief. No patient developed anaesthesia dolorosa, 2 patients had transient diplopia, 1 maxillary hematoma and 1 infection. 56 experienced recurrence, 43 needed further surgical intervention. 25 PBC twice, 11 thrice, 4 four times and 1 five times. Average time to first recurrence=32 months. 85% pain free at 1 year and 70% at 2 years.ConclusionsPBC is an effective procedure. With conservative approach, this procedure can be safely repeated.

Download Full-text

PWE-106 Comparative analysis of efficacy and safety of standard and simplified radiofrequency ablation protocols for dysplastic barrett’s oesophagus: a retrospective study

10.1136/gutjnl-2017-314472.351 ◽

2017 ◽

Author(s):

S Choi ◽

P Santos ◽

J Hartley ◽

V Sujendran ◽

M Di Pietro

Keyword(s):

Retrospective Study ◽

Comparative Analysis ◽

Radiofrequency Ablation ◽

Barrett’S Oesophagus ◽

Efficacy And Safety ◽

Barrett's Oesophagus

Download Full-text

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

Pain Medicine ◽

10.1093/pm/pnaa389 ◽

2020 ◽

Author(s):

Shuyue Zheng ◽

Xiuhua Li ◽

Liqiang Yang ◽

Liangliang He ◽

Guoqing Cao ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Trigeminal Neuralgia ◽

Activity Index ◽

Controlled Trial ◽

Gasserian Ganglion ◽

Idiopathic Trigeminal Neuralgia ◽

Plasma Ablation ◽

Masseter Muscles ◽

Maximum Voltage ◽

Anterior Temporalis

Abstract 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.

Download Full-text

CYBERKNIFE RADIOSURGERY FOR TRIGEMINAL NEURALGIA TREATMENT

Neurosurgery ◽

10.1227/01.neu.0000317313.46826.dc ◽

2008 ◽

Vol 62 (3) ◽

pp. 647-655 ◽

Cited By ~ 59

Author(s):

Alan T. Villavicencio ◽

Michael Lim ◽

Sigita Burneikiene ◽

Pantaleo Romanelli ◽

John R. Adler ◽

...

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Radiation Doses ◽

Maximal Dose ◽

Median Length ◽

Pain Medications ◽

Idiopathic Trigeminal Neuralgia ◽

Cyberknife Radiosurgery ◽

The Mean

Abstract OBJECTIVE Radiosurgery has gained acceptance as a treatment option for trigeminal neuralgia. We report our preliminary multicenter experience treating trigeminal neuralgia with the CyberKnife (Accuray, Inc., Sunnyvale, CA). METHODS A total of 95 patients were treated for idiopathic trigeminal neuralgia between May 2002 and October 2005. Radiosurgical dose and volume parameters were retrospectively analyzed in relation to pain response, complications, and recurrence of symptoms. Optimal treatment parameters were identified for patients who had excellent and sustained pain relief with no complications, including severe or moderate hypesthesia. RESULTS Excellent pain relief was initially experienced by 64 out of 95 patients (67%). The median time to pain relief was 14 days (range, 0.3–180 d). Posttreatment numbness occurred in 45 (47%) of the patients treated. Using higher radiation doses and treating longer segments of the nerve led to both better pain relief and a higher incidence of hypesthesia. The presence of posttreatment numbness was predictive of better pain relief. The overall rate of complications was 18%. At the mean follow-up time of 2 years, 47 of the 95 patients (50%) had sustained pain relief, all of whom were completely off pain medications. CONCLUSION The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70–85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5–12 mm).

Download Full-text