Demartini L, Conversa G, Bettaglio R, Bonezzi C, Marchesini M
Pain Unit, Clinical Scientific Institutes Maugeri, Pavia, Italy.
Saudi J Anaesth. 2021 Apr-Jun;15(2):109-115. doi: 10.4103/sja.sja_972_20. Epub 2021 Apr 1.
Trigeminal neuralgia present an incidence rates ranging between 5.9 and 12.6 per 100.000 persons; although not frequent, it is a pathology often characterized by intense pain, an extremely significant reduction in quality of life and medical therapy is not always effective or tolerated. In these cases, the patient can undergo interventional treatments including radiofrequency thermocoagulation. There are still doubts regarding the effectiveness over time, the injury parameters and the repeatability of the procedure.
We analyze patients with trigeminal pain undergo retrogasserian radiofrequency in a single center over a period of 8 years. The procedure was performed with the following parameters: Lesion time 60 sec, lesion temperature 70°C for first thermolesion 72°C for subsequent thermolesions. Duration of benefit, number of repetitions of the maneuver, and incidence of adverse events were assessed.
Totally, 122 patients with essential trigeminal neuralgia and 20 patients with trigeminal neuralgia secondary to multiple sclerosis were analyzed; almost all patients (96.5%) showed a significant reduction in pain after one or more procedures over time; 96.5 of the patients showed excellent pain relief after 1 (40%) or more procedures (60%). The average time between one procedure and the next was 26 months.
The use of time and temperature parameters chosen shows excellent efficacy, in line with the literature, with very low incidence of adverse events. The pain-free time between one procedure and the next does not seem to be a significant prognostic criterion which may or may not indicate the repetition of the procedure.
三叉神经痛的发病率为每10万人中有5.9至12.6例；虽然不常见，但这种疾病常以剧烈疼痛为特征，生活质量极度下降，且药物治疗并不总是有效或能被耐受。在这些情况下，患者可接受包括射频热凝术在内的介入治疗。关于该治疗随时间的有效性、损伤参数以及手术的可重复性仍存在疑问。
我们分析了在一个中心8年内接受半月神经节射频治疗的三叉神经痛患者。手术采用以下参数进行：损伤时间60秒，首次热损伤的温度为70°C，后续热损伤的温度为72°C。评估了获益持续时间、操作重复次数以及不良事件的发生率。
总共分析了122例原发性三叉神经痛患者和20例继发于多发性硬化的三叉神经痛患者；几乎所有患者（96.5%）随着时间的推移在一次或多次手术后疼痛显著减轻；96.5%的患者在1次（40%）或更多次（60%）手术后疼痛得到极好缓解。两次手术之间的平均时间为26个月。
所选用的时间和温度参数显示出极佳的疗效，与文献一致，不良事件发生率极低。两次手术之间的无痛时间似乎不是一个重要的预后标准，它可能表明也可能不表明需要重复手术。
