IMPROVING SAFETY AND EFFICACY OF RADIOFREQUENCY TRIGEMINAL RHIZOTOMY OF THE FORAMEN OVALE: PROCEDURAL TECHNIQUES TO OPTIMIZE TARGET LOCALIZATION AND CANNULATION
Study type: Feasibility – Prospective, single center
Publication: Journal of Pain Research 2019; 12 1465-74 (Link to PubMed)
Key Words: Mandibular TN – Foramen Ovale – monopolar (m) RFA –bipolar (b) RFA – CT images
In this study, the authors report the outcomes of a novel FO-RFA of the V3 mandibular nerve under CT-guidance using both mRFA and bRFA.
Clinical outcomes and complications of mRFA and bRFA under CT-guidance were evaluated in 26 patients with isolated V3-TN. Patients were followed-up for up to 27 months.
Primary outcome: Complete sensory block of the V3. Secondary outcomes: Presence of residual pain, recurrent pain, and adverse clinical effects.
Guidance: The FO was identified on axial CT images. Needle trajectory was simulated on CT-software to allow a safe path without bony impediments.
RF procedure: Both sensory and motor tests were performed at the distribution of V3. BSC cannulas (20-gauge, 5mm bevel-tip) were used to access the FO. RF was conducted at 90°C for 90 seconds.
STUDY RESULTS AND CONCLUSIONS
- Both extracranial monopolar and bipolar RF techniques, under CT guidance, led to complete and persistent V3 analgesia with a comparable minor risk of post-procedural facial hematoma.
- In the bipolar RF group, complete pain relief persisted in all patients (14/14) at 15 months follow/up. In the monopolar group, only one case (1/12) of recurrent pain was found at a 14 months follow-up.
- Authors report a 100% success rate of optimal needle placement and thus superiority to the standard approach.