Article
Percutaneous radiofrequency thermocoagulation for persistent idiopathic facial pain – a retrospective monocentric analysis
Perkutane Radiofrequenz-Thermokoagulation bei persistierendem idiopathischem Gesichtsschmerz – eine monozentrische retrospektive Analyse
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Authors
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Bilal Al Barim
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Lars Lemcke
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Stephanie Schipmann
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
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Walter Stummer
- Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Persistent idiopathic facial pain (PIFP), previously termed atypical facial pain, is a debilitating chronic pain condition with pain radiating to one or more of the trigeminal dermatomes. Typically there are no pathologies thatcan be identified duringworkup and causal therapies are not available.Therapy is symptomatic and various medical and interventional approaches are used.
The aim of this study was to evaluate the effectiveness of percutaneous radiofrequency thermocoagulation (PRTC) of the Gasserian ganglion (GG) in patients with PIFP and the duration of pain relief, as well as the identification of clinical and surgical factors associated with its success.
Methods: Data on all patients with PIFP between 2009 through 2019 that have been treated with PRTC of GG were included into the study.
PRTC was performed under intermittent propofol sedation via puncture in the middle third of the edge of the mandible and entering the foramen ovale through the skull base under fluoroscopic control.
After lifting propofol sedation the GG was stimulated and PRTC was performed in a range of 55 to 90°C after resuming sedation.
Outcome was assessed with a six tiered score from 1 (complete remission) to 6 (no benefit).
Chi-square test and univariate logistic regression was used for categorical and continuous variables, respectively. Odds ratio was obtained with 95% confidence intervals. Log-rank test was used for time to event analyses. Statistical significance was defined as p <0.05.
Results: 57 Patients were included with a median of 69 years. 61.4% of patients experienced pain relief after initial PRTC lasting for a median of 120 days. The second intervention was successful in 78.1% of patients, further procedures were successful in 84.4%. 13.8% could end all other treatments (Score 1), 29.3% experienced significant pain relief (Scores 2 and 3), 27.5% of Patients experienced mild pain relief (Scores 4 and 5). The remaining patients did not benefit (Score 6). Patient sex, number of repetitions, and number of affected branches were predictive factors for pain relief.
Conclusion: PRTC as an interventional form of therapy for PIFP appears a beneficial form of symptomatic treatment showing good pain relief, especially for patients with former pain relief through PRTC. Minimal invasiveness makes a repeatable intervention for patients suffering from PIFP. Further studies have to be performed to understand predictive factors in light of retrospective limitations of this study.
