[Neuronavigation-assisted percutaneous radiofrequency thermocoagulation of trigeminal gasserian ganglion for refractory craniofacial pain]

Puncture approaches and guidance techniques of radiofrequency thermocoagulation through foramen Ovale for primary trigeminal neuralgia: Systematic review and meta-analysis

Objective

Trigeminal neuralgia (TN) is one of the leading causes of facial pain and seriously affects patients' quality of life. Foramen ovale (FO) radiofrequency thermocoagulation is a classic approach for the treatment of TN that has failed pharmacological therapy. This study summarized the safety and efficacy of transforaminal radiofrequency thermocoagulation for TN by comparing puncture approaches or guidance techniques, thereby providing higher-quality clinical evidence.

Methods

Databases including PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched for relevant studies published before May 2022. Relevant data were extracted for analysis to compare methodological variables and clinical outcomes.

Results

This meta-analysis included 27 studies with a total of 1,897 patients. In terms of puncture approaches, FO had a significant advantage in reducing VAS at 12 months postoperatively (P = 0.019) and efficacy (P = 0.043). However, FO performed poorly on complications (P < 0.001), operation time (P < 0.001), and the number of needle adjustments (P < 0.001). Regarding the guidance techniques, the adjunctive use of guidance techniques could reduce patients' 6-month VAS (P < 0.001) and 12-month VAS (P < 0.001), improve the efficacy (P = 0.032), reduce recurrence rates (P = 0.001), shorten operation times (P < 0.001), decrease times of intraoperative fluoroscopy (P < 0.001), and improve the success of the first puncture (P < 0.001).

Conclusion

FO radiofrequency thermocoagulation has advantages in efficacy it can still better relieve the pain of patients 12 months postoperatively. However, FO has disadvantages in complications, recurrences, and operation time. The adjunctive use of guidance techniques has a positive effect on treatment efficacy and safety during FO radiofrequency thermocoagulation. However, the results still require large samples and high-quality randomized clinical trials to confirm.

A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia

OBJECTIVES

Radiofrequency thermocoagulation (RFT) is a type of Gasserian ganglion-level ablative intervention that is used for the treatment of trigeminal neuralgia. Guidance technologies are used to assist in the cannulation of the foramen ovale (FO) or foramen rotundum (FR) target. We conducted a systematic review to assess the value of different guidance technologies for RFT.

METHODS

We searched PubMed, Embase, the Cochrane database, Web of Science, and PROSPERO for studies published from January 2005 until December 2020. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and the nonrandomized studies of interventions-I tool were used to assess individual study characteristics and overall quality.

RESULTS

Our query identified 765 publications, and we were able to analyze 11 studies on patients suffering from trigeminal neuralgia. Only one study involved randomized controlled trials, whereas the others featured nonrandomized designs, predominantly before-and-after comparisons. Most of them were observational studies. A total of 222 participants were included, with a median number (range) of 20 (3-53) participants. The objective response rate (ORR) of the one-puncture success rate of RFT using puncture guidance for trigeminal neuralgia was 92% [95% CI (0.79-1), P < 0.001]. Statistically significant differences were observed in the cannulation and operation times between the guided and manual puncture groups (P < 0.001).

CONCLUSIONS

RFT with puncture guidance technology has an absolute advantage in puncturing the foramen ovale or foramen rotundum.