Clinical Observation Of Different Path Radiofrequency Thermocoagulation In The Treatment Of Trigeminal Maxillary Neuralgia

Objectives : In recent years,Radiofrequency Thermocoagulation(RFT)has been widely used in the treatment of trigeminal neuralgia.We observed the clinical efficacy of CT-guided RFT through foramen ovale(FO)versus foramen rotundum(FR)for the treatment of maxillary neuralgia.Methods : Between Sep,2018 and Jan,2020,40 subjects with primary maxillary neuralgia were randomly divided into two groups.Patients in the FO group were treated with Gasserian ganglion ablation through the Hartel approach,though patients in the FR group received ablation of the maxillary nerve at the internal opening of the foramen rotundum.The primary outcome were the pain relief and pain recurrence rate at 1 month,3 months,6 months and 1 year after surgery,using the Numerical Rating Scale(NRS)and the Barrow Neurology Institute score(BNI).The secondary outcome were the incidence of postoperative complications and patient satisfaction.Results:There was no significant difference in NRS scores between the FO group and the FR group before surgery(P>0.05).The NRS scores of two groups were significantly lower at 1 month(0.95±0.69 and 1.00±0.73;p=0.825)and 3 months(1.20±0.93 and 1.40±0.94,respectively;p=0.503)after surgery.However,no significant difference was found between the groups.At 6 months(1.35±0.81 and2.05±1.35,respectively;p=0.029)and 1 year after surgery(1.85±0.99 and2.95±1.46,respectively;p=0.008),the NRS scores of patients in the FO group were significantly lower than that in the FR group.At 1 year after surgery,the recurrence rate of patients in the FO group was significantly lower than that of the FR group(5% and 30%,respectively;p=0.037),and the patient satisfaction was significantly higher than that of the FR group(95% and 70%,respectively;p=0.037).However,the incidence of postoperative facial numbness(55% and 20%,respectively;p=0.047)and masticatory muscle weakness(25% and 0%,respectively;p=0.017)in the FO group was significantly higher than that in the FR group.Conclusions: For the treatment of maxillary neuralgia,CT-guided RFT through FO has better clinical efficacy and higher patient satisfaction.Although the incidence of complications was higher compared with RFT through FR,it could recover within 6months after surgery.We recommended RFT through foramen ovale.