Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University; Beijing, China.
Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Pain Physician. 2021 Dec;24(8):E1263-E1271.
At present, there is no ideal method for the treatment of trigeminal neuralgia (TN). The need for an easy, safe, non- or micro-neurodestructive, repeatable treatment, with a fairly satisfactory rate of pain relief, is paramount. Pulsed radiofrequency (PRF) as a minimally invasive and microdestructive technique has been reported to be an option for TN; however, no study has reported the long-term outcome of TN in a large case series.
We aimed to investigate the efficacy, safety, and the long-term outcomes of PRF treatment for patients with TN.
This was a long-term, large case series, retrospective study.
The study was conducted at Tiantan hospital,Beijing.
We retrospectively analyzed medical databases and follow-up data of 149 patients with TN from January 2008 through March 2021, who underwent PRF treatment, with a median follow-up time of 71.0 months (interquartile range, 20.0 months to 112.0 months). Baseline characteristics and intraoperative data of patients were retrospectively extracted; data about complications and side effects were also collected. The follow-up data were composed of the postoperative Barrow Neurological Institute Pain Intensity Score pain intensity at a different time, the onset time of PRF treatment, and the time when pain was recurrent.
The initial pain relief rate was 75.17% after the procedure. The cumulative recurrence-free survival after the procedure was 75.00% at one month; 72.87% at 6 months; 70.59% at 12 months; 65.39% at 24 months; 61.63% 48 months; 56.73% at 96 months; and 49.64% at 144 months. The median recurrence-free time was 118 months according to the Kaplan-Meier estimator. Nineteen patients had pain recurrence with a median time of 15 months (range, 1.0 months to 96.0 months), among whom, 12 underwent a second PRF procedure and 9 patients experienced satisfactory pain relief. No serious complications or side effects occurred after the procedure.
This was a single-center, retrospective study. Our study failed to conduct a stratified analysis on the effect of PRF treatment for classic and idiopathic TN. The most efficacious parameters of PRF applied for TN and studies trying to identify positive predictive factors of pain relief before PRF treatment have yet to be investigated.
The results of this study show the promising long-term effect of PRF on primary TN. The safety and repeatability might be more easily accepted by patients with TN and should be considered a preferred treatment option before choosing neurodestructive or more invasive methods.
目前，三叉神经痛（TN）的治疗方法并不理想。因此，需要一种简单、安全、非神经破坏性或微神经破坏性、可重复的治疗方法，并且具有相当令人满意的止痛缓解率。脉冲射频（PRF）作为一种微创和微破坏性技术，已被报道可用于治疗 TN；然而，尚无研究报道 PRF 治疗 TN 的大病例系列的长期结果。
我们旨在研究 PRF 治疗 TN 患者的疗效、安全性和长期效果。
这是一项长期、大病例系列、回顾性研究。
本研究在北京天坛医院进行。
我们回顾性分析了 2008 年 1 月至 2021 年 3 月期间接受 PRF 治疗的 149 例 TN 患者的医疗数据库和随访数据，中位随访时间为 71.0 个月（四分位距，20.0 个月至 112.0 个月）。回顾性提取患者的基线特征和术中数据；还收集了并发症和副作用的数据。随访数据包括术后巴罗神经研究所疼痛强度评分（疼痛强度在不同时间的变化）、PRF 治疗的开始时间和疼痛复发的时间。
术后即刻缓解率为 75.17%。术后 1 个月累积无复发生存率为 75.00%；6 个月时为 72.87%；12 个月时为 70.59%；24 个月时为 65.39%；48 个月时为 61.63%；96 个月时为 56.73%；144 个月时为 49.64%。根据 Kaplan-Meier 估计，中位无复发时间为 118 个月。19 例患者出现疼痛复发，中位时间为 15 个月（范围，1.0 个月至 96.0 个月），其中 12 例再次接受 PRF 治疗，9 例患者疼痛缓解满意。术后无严重并发症或副作用发生。
这是一项单中心、回顾性研究。我们的研究未能对 PRF 治疗经典和特发性 TN 的效果进行分层分析。用于 TN 的 PRF 的最有效参数以及在 PRF 治疗前试图确定疼痛缓解的阳性预测因素的研究尚未进行。
本研究结果表明 PRF 对原发性 TN 具有有前景的长期疗效。其安全性和可重复性可能更容易被 TN 患者接受，并且在选择神经破坏性或更具侵袭性的方法之前，应将其视为首选治疗方法。
