Comparison of High-voltage- with Standard-voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia.

Abstract

Although pulsed radiofrequency treatment (PRFT) has been used to treat trigeminal neuralgia (TN) safely, satisfactory improvement is lacking. Recently, much attention has been paid to the PRFT dose and intra-operative parameters. It has been reported that high-voltage PRFT could significantly reduce discogenic pain. However, there is no study investigating the effects of high-voltage PRFT on TN. The aim of this prospective, randomized, double-blinded study was to evaluate the efficacy and safety of high-voltage PRFT in comparison with standard-voltage PRFT for idiopathic TN. Sixty severe TN patients were randomly assigned to 2 groups treated with CT-guided standard- or high-voltage-pulsed radiofrequency (RF) of Gasserian ganglion, respectively, between January 2012 and July 2012. Numeric Rating Scales (NRS), carbamazepine dose, and side effects were evaluated at day 1, weeks 1 and 2, months 1, 3, and 6, and 1 year postoperative. There were 27 patients in the standard-voltage group and 26 patients in the high-voltage group who completed the 1-year follow-up study. The effective rates in the standard-voltage and high-voltage PRFT groups were 41% and 69%, respectively, at 1, 3, and 6 months postoperative (P = 0.037). The effective rate in the standard-voltage group decreased to 19% at 1-year postoperative, while in the high-voltage group remained at 69% (P = 0.000). No significant side effects were detected in both groups. In conclusion, CT-guided high-voltage PRFT is an effective and safe interventional therapeutic choice for idiopathic TN patients.