The Role of Percutaneous Radiofrequency Thermocoagulation for Persistent or Recurrent Trigeminal Neuralgia After Surgery

Therapeutic strategy is controversial and not yet uniform for patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression, percutaneous radiofrequency thermocoagulation (PRT), or Gamma Knife surgery. The outcomes and risks of PRT for these patients are not clearly understood. The authors performed a retrospective study of 84 patients with persistent or recurrent TN after surgery who then underwent PRT between 2007 and 2013. Data were obtained with chart review and telephone interviews. The mean follow-up duration was 44.2 months. The immediate pain relief after PRT was 98%. The survival rates of pain free without medications at 1, 2, and 3 years after PRT were 85%, 68%, and 54%, respectively, with a nearly 80% rate for effective pain control (pain free, or pain controlled with medications) during the study period. The previous surgical method for TN did not have a significant effect on pain-free rates (P >0.05). Ninety-five percent of patients benefited from multiple PRT procedures and were satisfied with their pain relief. Fourteen of 17 patients who required retreatment selected additional PRT, resulting in 8 patients (57%) in excellent outcome and 12 (86%) in effective pain control. Two patients had failed all conventional invasive treatments. All patients experienced numbness of varying degrees, with 2 reporting severe and bothersome numbness. The complication rate was 15%, including 6 patients with masseter weakness, 2 patients with impaired taste acuity, 4 patients with absent or decreased corneal reflex, 1 patient with oculomotor paralysis. Percutaneous radiofrequency thermocoagulation is a safe and efficacious therapeutic method for patients with persistent or recurrent TN after surgery. Percutaneous radiofrequency thermocoagulation can serve as an alternative treatment option for these patients.