Efficacy and Safety of Repeated Radiofrequency Thermocoagulation on Trigeminal Neuralgia Patients

TL;DR

This study shows that repeated radiofrequency thermocoagulation for trigeminal neuralgia becomes less effective and more risky with each procedure, especially after the third.

Contribution

The study provides new insights into the diminishing effectiveness and increasing complication rates of repeated RFTC procedures for trigeminal neuralgia.

Findings

79% of patients had excellent or good response after the first RFTC, but this dropped to 42.3% after the third.

Complication rates increased with each procedure, reaching 42.9% after the third RFTC.

Painful post-traumatic trigeminal neuropathy increased from 1.4% after the first to 13.8% after the third procedure.

Abstract

Trigeminal neuralgia (TN) is a pain condition characterized by paroxysmal, electric shock‐like facial pain, affecting one or more areas of the branches. Approximately 33%–50% of patients require invasive treatment. Radiofrequency thermocoagulation (RFTC) is an established method for managing drug‐resistant and chronic TN. This study evaluates treatment response quality and complication rates in repeated RFTC procedures for TN patients.

In this retrospective analysis, patient records were extracted from the electronic medical records of Kuopio University Hospital, using the trigeminal neuralgia diagnosis code and the procedure code for thermal destruction of a cranial nerve. Data collected included sex, age, treatment outcomes at 3‐month follow‐up, presence of complications, technical details, and procedural success for each intervention.

Data from 140 patients were analyzed. An excellent or good response was observed in 79% of patients after the first procedure, 62.9% after the second, and 42.3% after the third. Complication rates were 15.7%, 19.6%, and 42.9%, respectively. Logistic regression analysis showed that complication risk was significantly associated with tertiary procedure and female sex. Development of painful post‐traumatic trigeminal neuropathy (PTTN) was more common after repeated interventions; 1.4% after the first, 3.1% after the second, and 13.8% after the third procedure.

RFTC is an effective and safe method for treatment for persistent trigeminal neuralgia when conservative treatment fails. However, its benefits diminish, and risks increase with each additional procedure, particularly the third. Based on these findings, reintervention should generally be limited to a single repeat procedure.

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