A Novel Sequential Percutaneous Radiofrequency Treatment Strategy for Drug-refractory Trigeminal Neuralgia: A Propensity Score-matched Study.

Background: Gasserian ganglion-targeted conventional and pulsed radiofrequency treatments are percutaneous procedures performed for drug-refractory trigeminal neuralgia. However, ideal outcomes are not always achieved with these procedures; frequent postprocedural complications and therapeutic ineffectiveness are also of major concern.

Objectives: This study was conducted to investigate a novel strategy for effective, uncomplicated pain relief in patients with drug-refractory trigeminal neuralgia.

Study design: A multicenter, retrospective, observational study.

Setting: Participating centers were Beijing Tiantan Hospital and Sanbo Brain Hospital.

Methods: From January 2010 through December 2019, a total of 2,087 patients with drug-refractory trigeminal neuralgia were included in the current study. Of them, 143 underwent sequential conventional radiofrequency treatment and 1,944 underwent conventional radiofrequency treatment only. The primary outcome was being pain free at 24 months postprocedure; multiple secondary outcomes were compared between treatments before and after propensity score matching.

Results: At the 24-month follow-up, sequential radiofrequency treatment provided a higher pain-free outcome than conventional radiofrequency treatment (0.93 [95% CI, 0.92-0.94]) vs 0.89, (95% CI, 0.84-0.94; P = 0.04); hazard ratio, 1.703 (95% CI, 1.01-2.86). For the 124 propensity score-matched pairs, there was no significant difference between groups, although pain-free outcomes were numerically higher in the sequential radiofrequency treatment group (0.93 [95% CI, 0.89-0.98]) vs 0.90 (95% CI, 0.85-0.96; P = 0.3); hazard ratio, 0.653 (95% CI, 0.27-1.60). Notably, sequential radiofrequency treatment correlated with fewer overall postprocedural complications than conventional radiofrequency treatment, despite propensity score matching analysis (14/143 vs 723/1944, relative risk, 0.69 (95% CI, 0.65-0.74; P < 0.001); 11/124 vs 45/124, relative risk 0.69 (95% CI, 0.60-0.80; P < 0.001).

Limitations: Procedural parameters and quality of life evaluation by treatment were not analyzed and cost data were not collected.

Conclusion: Sequential radiofrequency treatment has the potential to provide effective, uncomplicated, pain-free outcomes.