Efficacy and Safety of Radiofrequency Thermocoagulation with Different Puncture Methods for Treatment of V1 Trigeminal Neuralgia: A Prospective Study

BACKGROUND: Radiofrequency thermocoagulation through the supraorbital foramen with a different puncture method is a new approach for the treatment of ophthalmic division trigeminal neuralgia. OBJECTIVES: To compare the efficacy of the vertical puncture method and the transverse puncture method in the treatment of ophthalmic division trigeminal neuralgia during radiofrequency thermocoagulation through the supraorbital foramen. STUDY DESIGN: Randomized, longitudinal prospective, clinical research study. SETTING: Department of Anesthesiology and Pain Medicine, Jiaxing, China. METHODS: A total of 57 patients with ophthalmic division trigeminal neuralgia were enrolled in the study between October 2011 and April 2018, and prospectively randomized into the vertical puncture group (n = 29) or transverse puncture group (n = 28). All these patients received computed tomography guided radiofrequency thermocoagulation through the supraorbital foramen. Patients in the vertical puncture group were treated with a vertical puncture method; patients in the transverse puncture group received a transverse puncture method. Facial pain was evaluated using the Numeric Rating Scale preoperatively and at 1 day, 6 months, 1 year, and 2 years after treatment; facial numbness degree was analyzed at 1 day and 2 years after the treatments were recorded. The short-term and long-term complications during the period of postoperative follow-up were recorded. RESULTS: All surgical procedures were successfully completed. The Numeric Rating Scale scores at 6 months, 1 year, and 2 years after the treatment were significantly lower in the transverse puncture group compared to the vertical puncture group (P < 0.05), while no difference was observed on day one after the treatment (P > 0.05). The numbness degree at 2 years was significantly decreased compared to day one in both groups (P < 0.05). The radiofrequency thermocoagulation for ophthalmic division trigeminal neuralgia in the transverse puncture group showed better long-term outcomes than those in the vertical puncture group (P < 0.05). No short-term or long-term postoperative complications were observed in any of the groups. LIMITATIONS: Additional clinical data should be collected to preserve the results in future work. CONCLUSION: The transverse puncture method during radiofrequency thermocoagulation through the supraorbital foramen had better efficacy and fewer complications in comparison with the vertical puncture method when treating ophthalmic division trigeminal neuralgia. KEY WORDS: Trigeminal neuralgia, radiofrequency thermocoagulation, supraorbital foramen