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      Treatment of Supraorbital Neuralgia Using Ultrasound-Guided Radiofrequency Thermocoagulation of the Supraorbital Nerve: A Retrospective Study

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          Abstract

          Purpose

          There is no standard clinical treatment protocol for supraorbital neuralgia patients who respond poorly to conservative treatment. Radiofrequency thermocoagulation, a neurologically damaging procedure, is a treatment for supraorbital neuralgia. However, assessments of its long-term efficacy are lacking. Thus, this study aimed to evaluate the long-term efficacy and safety of ultrasound-guided radiofrequency thermocoagulation for treating supraorbital neuralgia.

          Patients and Methods

          We retrospectively reviewed our clinical database for supraorbital neuralgia patients who underwent an ultrasound-guided radiofrequency thermocoagulation procedure. Demographic data and baseline characteristics, time of onset, postoperative pain intensity, time of recurrence, subsequent treatment, complications and side effects were collected and analysed. The Kaplan-Meier estimator was used to determine recurrence-free survival.

          Results

          A total of 53 supraorbital neuralgia patients were included in this study. All patients experienced complete pain relief within one month. The median follow-up time of the 53 patients was 36.0 months (IQR, 12.0–72.0 months). A total of 13 patients experienced pain recurrence, with a median recurrence-free time of 97 months according to the Kaplan-Meier estimator. The cumulative proportion of recurrence-free survival was 96.2% at 12 months, 88.4% at 24 months, 82.7% at 36 months, 70.0% at 48 months, 66.3% at 60 months, and 49.7% at 97 months. All but one patient with recurrent pain underwent a second or third radiofrequency thermocoagulation procedure and achieved complete pain relief. Numbness of supraorbital nerve innervation occurred in all patients. However, the numbness scores gradually decreased over time.

          Conclusion

          Ultrasound-guided radiofrequency thermocoagulation is a safe, effective treatment for supraorbital neuralgia patients who respond poorly to conservative treatments. These patients attained excellent long-term pain relief with a gradual reduction in numbness.

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          Most cited references 37

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          Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients.

          The objective of this study was to evaluate the effectiveness of percutaneous, controlled radiofrequency trigeminal rhizotomy (RF-TR). The outcome of 1,600 patients with idiopathic trigeminal neuralgia after RF-TR was analyzed after a follow-up period of 1 to 25 years. A total of 1,600 patients with idiopathic trigeminal neuralgia underwent 2,138 percutaneous radiofrequency rhizotomy procedures between 1974 and 1999. Sixty-seven patients had bilateral idiopathic trigeminal neuralgia, and 36 of them were treated with bilateral RF-TR; 1,216 patients (76%) were successfully managed with a single procedure, and the remainder were treated with multiple procedures. Benzodiazepines and narcotic analgesics were used for anesthesia because patient cooperation during the procedures was essential so that the physician could create selective, controlled lesions. The average follow-up time was 68.1 +/- 66.4 months (range, 12-300 mo). Acute pain relief was accomplished in 97.6% of patients. Complete pain relief was achieved at 5 years in 57.7% of the patients who underwent a single procedure. Pain relief was reported in 92% of patients with a single procedure or with multiple procedures 5 years after the first rhizotomy was performed. At 10-year follow-up, 52.3% of the patients who underwent a single procedure and 94.2% of the patients who underwent multiple procedures had experienced pain relief; at 20-year follow-up, 41 and 100% of these patients, respectively, had experienced pain relief. No mortalities occurred. After the first procedure was performed, early pain recurrence (<6 mo) was observed in 123 patients (7.7%) and late pain recurrence was observed in 278 patients (17.4%). Complications included diminished corneal reflex in 91 patients (5.7%), masseter weakness and paralysis in 66 (4.1%), dysesthesia in 16 (1 %), anesthesia dolorosa in 12 (0.8%), keratitis in 10 (0.6%), and transient paralysis of Cranial Nerves III and VI in 12 (0.8%). Permanent Cranial Nerve VI palsy was observed in two patients, cerebrospinal fluid leakage in two, carotid-cavernous fistula in one, and aseptic meningitis in one. Percutaneous, controlled RF-TR represents a minimally invasive, low-risk technique with a high rate of efficacy. The procedure may safely be repeated if pain recurs.
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            Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review

            Background The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality. Methods We systematically searched for clinical studies on PRF. We searched the MEDLINE (PubMed) and EMBASE database, using the free text terms: pulsed radiofrequency, radio frequency, radiation, isothermal radiofrequency, and combination of these. We classified the information in two tables, one focusing only on RCTs, and another, containing prospective studies. Date of last electronic search was 30 May 2010. The methodological quality of the presented reports was scored using the original criteria proposed by Jadad et al. Findings We found six RCTs that evaluated the efficacy of PRF, one against corticosteroid injection, one against sham intervention, and the rest against conventional RF thermocoagulation. Two trials were conducted in patients with lower back pain due to lumbar zygapophyseal joint pain, one in cervical radicular pain, one in lumbosacral radicular pain, one in trigeminal neuralgia, and another in chronic shoulder pain. Conclusion From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
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              Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute

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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                29 January 2020
                2020
                : 13
                : 251-259
                Affiliations
                [1 ]Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University , Beijing, People’s Republic of China
                Author notes
                Correspondence: Fang Luo; Ying Shen Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University , No. 119 West Road, South 4th Ring Road, Fengtai District, Beijing100050, People’s Republic of ChinaTel +86 13611326978; +86 18610791617 Email luofangwt@yahoo.com; shenying1937@hotmail.com
                [*]

                These authors contributed equally to this work

                Article
                228720
                10.2147/JPR.S228720
                6996227
                © 2020 Ren 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. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 1, References: 47, Pages: 9
                Categories
                Original Research

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