1. 2021;24;587-596Comparison of Efficacy and Safety of CT-Guided Radiofrequency Thermocoagulation Through Foramen Rotundum Versus Foramen Ovale for V2 Primary Trigeminal Neuralgia
   Prospective Study
   Peng Yao, PhD, Tao Hong, MD, Hongxi Li, MD, and Yuanyuan Ding, PhD.

BACKGROUND: Primary trigeminal neuralgia (TN) is one of the most severe facial pain syndromes. TN affects patients’ quality of life and, when severe, can lead to depression and increase social burden.

OBJECTIVES: This retrospective study aimed to compare efficacy and safety of computed tomographic (CT)-guided percutaneous radiofrequency thermocoagulation (RFT) through the foramen rotundum (FR) versus through the foramen ovale (FO) for treatment of maxillary division (V2) TN.

STUDY DESIGN: A prospective study.

SETTING: Shengjing Hospital of China Medical University.

METHODS: Seventy patients with V2 TN were randomly assigned to 2 groups: RFT-FR group (n = 35) and RFT-FO group (n = 35). Visual Analog Scale (VAS), the Medical Outcomes Study 36-Item Short-Form Health Survey, the total efficacy, complications, and recurrence rate were assessed before and after surgery at different time points.

RESULTS: Compared with the preoperative VAS, the postoperative VAS in the RFT-FR and RFT-FO groups both decreased significantly (P < 0.05). There was no significant difference in VAS between the 2 groups (P > 0.05); in both groups quality of life improved to varying degrees after RFT. In the RFT-FO group, the physical component summary (PCS) and mental component summary (MCS) were significantly lower than in the RFT-FR group at 1 week, 2 weeks and 1 month (P < 0.05). After 3 months, the PCS and MCS of the RFT-FO group gradually increased, so the 2 groups no longer differed significantly (P > 0.05). The total incidence of complications in the RFT-FR and RFT-FO groups was 20.0% (7/35) and 62.9% (22/35), respectively, and differed significantly (P < 0.05).

LIMITATIONS: This study cohort size is small, but we will gradually increase the number of patients later. Second, there may be acquiescence bias or response bias. Third, the punctures under the more commonly used C-arm imaging guidance deserve to be evaluated in the future.

CONCLUSIONS: CT-guided RFT through the FR and FO are both an effective, minimally invasive treatments for V2 TN that can relieve pain effectively.
 
KEY WORDS: Radiofrequency thermocoagulation, primary trigeminal neuralgia, foramen rotundum, foramen ovale, neuropathic pain