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      Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis

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          The objective of this study was to summarize the effectiveness and safety of trigeminal neuralgia (TN) treatment via different radiofrequency approaches such as continuous radiofrequency (CRF), pulsed radiofrequency (PRF), and combined CRF and pulsed radiofrequency (CCPRF) treatments, thus providing high-quality clinical evidence for TN treatment.


          A series of databases were searched for relevant articles published between January 1998 and April 2018. The modified Jadad scale was referred to evaluate the methodological quality of the included studies. Data were extracted independently, and the outcome and safety of different routes, temperatures, and guidance used in CRF, PRF, and CCPRF were compared. Meta-analysis and publication bias were calculated using Review Manager software.


          In total, 34 studies involving 3,558 participants were included. With regard to TN treatment, PRF had no difference in cured rate in comparison with CRF, while CRF was more effective than CCPRF ( P<0.05). The comparison of complication rates showed that PRF and CCPRF were safer. For puncture guidance via CRF, three-dimensional-printed template was more accurate in success rate at first puncture than computed tomography guidance ( P<0.05). For puncture route, foramen rotundum (FR) or pterygopalatine fossa (PPF) route had no significance in efficiency rate via CRF in comparison with foramen oval (FO) route, but PPF and FR routes were safer. For CRF treatment, low temperature (68°C–70°C) compared with high temperature (71°C–75°C) had no effect. Moreover, higher temperature (66°C–80°C) had a greater effect compared with lower temperature (55°C–65°C) on TN treatment ( P<0.05), while the safety of which was decreasing.


          CCPRF could achieve a greater effect and safety on TN treatment. FR and FO routes in TN puncture treatment via CRF are safer. Medium temperature range is better for CRF therapy, and higher temperature is recommended in PRF, especially for the elders. Further international multicenter trials are needed to confirm the evidence.

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          Most cited references 52

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          The International Classification of Headache Disorders: 2nd edition.

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            Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia.

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              Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia.

              The aim of this prospective, randomized, double-blinded study was to evaluate the effect of pulsed radiofrequency (PRF) in comparison with conventional radiofrequency (CRF) in the treatment of idiopathic trigeminal neuralgia. A total of 40 patients with idiopathic trigeminal neuralgia were included. The 20 patients in each group were randomly assigned to one of the two treatment groups. Each patient in the Group 1 was treated with CRF, whereas each patient in the Group 2 was treated by PRF. Evaluation parameters were: pain intensity using a Visual Analogue Scale (VAS), patient satisfaction using a Patient Satisfaction Scale (PSS), additional pharmacological treatment, side effects, and complications related to the technique. The VAS scores decreased significantly (p<0.001) and PSS improved significantly after the procedure in Group 1. The VAS score decreased in only 2 of 20 patients from the PRF group (Group 2) and pain recurrence occurred 3 months after the procedure. At the end of 3 months, we decided to perform CRF in Group 2, because all patients in this group still had intractable pain. After the CRF treatment, the median VAS score decreased (p<0.001) and PSS improved (p<0.001) significantly. In conclusion, the results of our study demonstrate that unlike CRF, PRF is not an effective method of pain treatment for idiopathic trigeminal neuralgia.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                18 January 2019
                : 12
                : 423-441
                [1 ]Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, People’s Republic of China
                [2 ]Department of Otorhinolaryngology, Affiliated Hospital of Nantong University, Nantong 226001, People’s Republic of China, entnhs@ 123456ntu.edu.cn
                Author notes
                Correspondence: Haosheng Ni, Department of Otorhinolaryngology, Affiliated Hospital of Nantong University, 20 Xisi Street, Nantong 226001, People’s Republic of China, Tel +86 513 8505 1891, Fax +86 513 8505 1820, Email entnhs@ 123456ntu.edu.cn

                These authors contributed equally to this work

                © 2019 Wu et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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