Efficiency Of Gasserian Ganglion Percutaneous Radiofrequency Thermocoagulation For Idiopathic Trigeminal Neuralgia

BackgroundTrigeminal neuralgia(TN)is a common neuropathic pain disorder that occurs in the elderly,and female have a higher incidence than male.The main clinical manifestation of TN is recurrent,intense,paroxysmal,electric shock-like pain in the distribution of trigeminal nerve.Most of the pain are intermittent attack,usually lasts from few seconds to 1 minute,can be accompanied by ipsilateral facial muscle spasm.Patients with the mouth corners,nose,cheek and tongue for sensitive areas,light touch like washing,eating and tooth brushing can induce pain,known as the trigger point.TN can be divided into two types:primary TN and secondary TN.Primary TN does not show any signs of nervous system,nor does it have obvious organic or functional lesions;Secondary TN is due to intracranial organic disease,such as intracranial tumors,multiple sclerosis.The pain to a lesser degree,and its onset duration is longer,or shown as persistent pain with paroxysmal aggravation.Abnormal physical signs can be found in the nervous system.The cause of primary TN remains unclear,and prone to relapse.At present,drug is still the first-line treatment for primary TN,while drug dosage increased along with the progress,which can produce drug resistance and serious side effects,leading to poor patient compliance.Local nerve block can release pain to some degree,but it is easy to relapse in a short time.Microvascular decompression(MVD)and other surgery therapy do large trauma to the patients,elderly and patients with underlying disease can not afford the risk of surgery.Therefore,although there are varied choices for the treatment of primary TN,but the effect was not satisfactory,treatment of primary TN is still a troublesome problem in the clinical.ObjectiveTo investigate the effect of gasserian ganglion PRT in the treatment of primary TN,including duration pain-free,recurrence rate and complications,and to provide guidance for clinical treatment.Methods205 patients suffering from idiopathic TN received PRT of gasserian ganglion treatment in department of pain medicine from 2002 to 2013.Immediate outcomes,recurrence rate and complications were obtained from their medical records and questionnaires sent in May 2014.Postoperative effect was divided into three levels:recovery,improvement,and uncovered.Chi-square test,Log-rank analysis was used to analysis the relationship between patients’ age,gender,lesion branches,side,radiofrequency temperature,time and curative effect,the influence of the recurrence and complications,P<0.05 was considered statistically significant,using Cox regression model to assess the effect of radiofrequency temperature and time on the incidence of complications.All patients with a minimum follow-up of 5 months.ResultsIn the 205 patients,two patients were lost to follow up.The immediate postoperative effective rate(including excellent and good)was 91.13%(186 of 203).Total recurrence rate was 13.79%(28 of 203),and the first three year accounted for 75.0%(21 of 28).The complications incidence was 77.83%(158/203).Among them,151 patients suffered hypoesthesia and numbness,20 had keratitis,8 patients had motor weakness of the masseter muscle,1 had tinnitus,1 patient vomit after surgery.Most patients had more than one complications,but all were transient and mild symptoms.These complications were recovered within 3 months,no serious neurological sequelae.Chi-square test and Log-rank analysis results showed that age,gender,lesion branches,side,radiofrequencytemperature and time had no significant effect on the curative effect and recurrence(P>0.05),but the radiofrequency time and temperature associated with the occurrence of complications(P<0.05),the Cox regression model analysis showed that high temperature and long time radio frequency can increase the incidence of complications.Conclusion1.The C-arm guided Gasserian ganglion PRT can effectively relieve pain,with a low recurrence rate.Complications occurred to different extent,but can recovered in a short time,no serious sequelae,It is an effective method for TN.2.The patient’s age,gender,lesion branch,side,radiofrequencytemperature and time had no significant effect on the curative effect and recurrence rate,but the high temperature and long time of the radiofrequency can increase the incidence of postoperative complications.Therefore,long time and high temperature should be avoided in operation.After surgery can appear all sorts of complications,we should pay attention to postoperative nursing,especially to prevent eye complications.