PERCUTANEOUS RADIOFREQUENCY THERMORHIZOTOMY EFFECTIVENESS IN REFRACTORY TRIGEMINAL NEURALGIA

M. Storari¹, D. Viscuso², S. Mameli³ | ¹Libero professionista in Milano, Cagliari, Vicenza, Italy; ²Istituto Stomatologico Italiano, Milano e Università di Cagliari, Italy; ³Ospedale Oncologico Businco, Cagliari, Italy

Introduction. Trigeminal neuralgia (TN) is a chronic painful with disorder, a very typical clinical phenotype, lancinating and short-lasting. recurrent unilateral brief electric shock-like pains, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli. TN treatment is initially pharmacological in the form of monotherapy; however, combined therapy with different drugs may be used. Sodium channel blockers - Carbamazepine and Oxcarbazepine - and calcium channel blockers -Pregabalin, Gabapentin - are first line therapies.
Materials & Methods. The main purpose of the current trial was to define the average duration over time of the Percutaneous Radiofrequency Thermorhizotomy (PRT) in individuals with TN refractory to drugs. Both Classical, secondary and diopathic forms of TN were investigated.The current retrospective cohort study consisted of Italian noninstitutionalized adults aged 18 years or older in treatment for TN at the University of Cagliari and Pain Center Businco Hospital of Cagliari. Eligible patients were those with refractory TN who underwent PRT from January 2010 to June 2021. Chi^2 test, with 0.05 as alpha, and the ANOVA test were used to establish the symptoms' recovery and the effect duration of PRT, respectively..
Results. A total of 29 patients were recruited in the final sample for a total of 68 PRT performed. Participants were mostly were female (66.18%) aged from 44 to 84 years old. The most common TN subtype found was TN secondary to Multiple Sclerosis. Half of the patients were in treatment with Carbamazepine, almost one out of four with Lamotrigine, 15% with Pregabalin, 9% with Oxcarbazepine. By contrast, only two patients were prescribed with an association of drugs. More than one out of three patients underwent only once to PRT and the 32% of the total sample needed thermorhizotomy twice. In the 65% of cases individuals stopped dugs’ intake after PRT. In the 75% of all cases patients reported the complete recovery of symptoms after the PRT while only a partial reduction was referred in the 20.50% of cases (at least 2 points less in the VAS scale). By contrast, in less than 5% of cases no improvements were showed after the surgical procedure. On average, the effects of PRT were demonstrated to last 26 months and 31 days. The maximum value of duration emerged to be 9 years and 11 months, by contrast the minimum was one month.
Conclusions. The current study was developed to evaluate the average duration of thermorhizotomy benefits over he time in individuals affected from TN refractory to drugs.