Safety and efficacy of percutaneous radiofrequency thermocoagulation with varying puncture trajectories for recurrent maxillary trigeminal neuralgia: a prospective study.

BACKGROUND

Recurrence of maxillary trigeminal neuralgia (TN) poses a significant clinical challenge. Percutaneous radiofrequency thermocoagulation (PRT) has been established as an effective treatment for maxillary TN. However, the safety and efficacy of different puncture pathways, particularly in the context of pain recurrence, may vary.

OBJECTIVE

This study aimed to compare the safety and efficacy of PRT via the foramen ovale (FO) and pterygopalatine fossa (PF) approaches for recurrent maxillary TN.

METHODS

This prospective, non-randomized controlled study included 46 patients with recurrent maxillary TN who underwent PRT at our hospital between January 2021 and June 2021. Patients were divided into two groups based on the puncture pathway: the FO group and the PF group. All procedures were performed under local anesthesia and guided by computed tomography (CT). Operative complications were monitored, and pain was assessed using the Visual Analog Scale (VAS) and the Barrow Neurological Institute (BNI) scale. Follow-up evaluations were conducted at 6, 12, 18, and 24 months postoperatively.

RESULTS

The efficacy rates of the two puncture pathways within 24 months were 69.5% (FO group) and 78.2% (PF group), respectively. All patients experienced hypoesthesia in the maxillary nerve area. No severe complications, such as blindness, intracranial hemorrhage, or intracranial infection, were observed in either group.

CONCLUSION

Both the FO and PF puncture pathways for PRT are safe and effective for treating recurrent maxillary TN. However, for patients with a history of prior PRT or percutaneous balloon compression (PBC) targeting the Gasserian ganglion, the PF approach may be preferable.