Clinical Efficacy And Adverse Reactions Of Radiofrequency Thermocoagulation And Balloon Compression In The Treatment Of Primary Trigeminal Neuralgia

Objective:To retrospectively analyze the clinical effect of percutaneous trigeminal semilunar ganglion radiofrequency thermocoagulation(RFT)and percutaneous balloon compression(PBC)in the treatment of primary trigeminal neuralgia(PTN).Methods:A total of 109 patients with PTN who were treated with RFT and PBC in the First Hospital of Shanxi Medical University from January 2019 to June 2020 were collected,48 patients who underwent RFT treatment were defined as the RFT group,and 61 patients who underwent PBC treatment were defined for the PBC group.The following data of patients were recorded through electronic medical records,general conditions:gender,age,preoperative comorbidities,side,branch,nature of pain,disease course,drug treatment effect and imaging examination.Intraoperative data: RFT group anesthesia method,approach,parameters(temperature,time,frequency);PBC group anesthesia method,approach,parameters(pressure,time,volume);general anesthesia and intraoperative medication;intraoperative vital signs of patients(maximum systolic blood pressure,minimum heart rate);total hospitalization days.The oral description of the patients was followed up by electronic medical records,follow-up records and telephone,and the Visual analogue scales(VAS)scores were obtained before,3 days,7days,15 days and 30 days after the operation.The Barrow Neurological Institute(BNI)pain score was used to record the treatment effects of the two groups at 1 month,3 months,6 months and 12 months after the operation.Postoperative BNI pain score grade Ⅰ upgraded to grade Ⅱ ～ Ⅴ was regarded as recurrence,and the patients with postoperative recurrence were recorded.Postoperative adverse reactions were recorded: cheek numbness,decreased masticatory muscle strength,herpes labialis and corneal discomfort.All patients were followed up for 12～30 months,with an average of 22.20±4.56 months.The highest value of systolic blood pressure,the lowest value of heart rate,the total length of hospital stay,and the VAS score before and after surgery were compared between the two groups.The degree of pain at different time points after surgery were compared between the two groups by repeated measures analysis.The incidence of adverse reactions and recurrence rates in the two groups were analyzed by chi-square test.Results:1、The highest intraoperative systolic blood pressure in the RFT group and the PBC group were(148.71±13.66)mm Hg and(142.87±12.09)mm Hg,respectively,and the RFT group was higher than the PBC group(P<0.05).The lowest central rate of operation in the RFT group and the PBC group were(57.79±6.83)times per minute and(63.10±9.87)times per minute,respectively,and the RFT group was significantly lower than the PBC group(P<0.01).2、The total hospitalization days of patients in RFT group and PBC group were 7.0(5.0,8.0)days and 7.0(4.0,9.5)days,respectively,and there was no significant difference between the two groups(P>0.05).3、There was no significant difference in the VAS score between the RFT group and the PBC group before surgery(P>0.05).The VAS scores in the PBC group were lower than those in the RFT group at 3 days,7 days,15 days and 30 days after operation(P<0.05).4、In the PBC group,the total effective rates were 100.00%,96.72%,96.72%,and95.08% at 1 month,3 months,6 months and 12 months after the operation,respectively.The total effective rates in the RFT group were 93.75%,93.75%,91.67% and 87.50% at1 month,3 months,6 months and 12 months after the operation,respectively.The total effective rate of the PBC group was higher than that of the RFT group,but the difference was not statistically significant(P> 0.05).5、The incidence of cheek numbness in the PBC group(78.69%)was higher than that in the RFT group(58.33%)(P<0.05).The incidence of decreased masticatory muscle strength in the PBC group(37.70%)was significantly higher than that in the RFT group(6.25%)(P<0.01).The incidence of herpes labialis in the PBC group(16.39%)was higher than that in the RFT group(2.08%)(P<0.05).The incidence of corneal discomfort in the PBC group(29.51%)was higher than that in the RFT group(10.42%)(P<0.05).6、The postoperative follow-up of the two groups of patients showed that within 12 months,15 patients(31.25%)in the RFT group had recurrence after surgery,and 8patients(13.11%)in the PBC group,and the recurrence rate in the RFT group was higher than that in the PBC group(P<0.05).More than 12 months,there were 5 new recurrences(10.4%)in the RFT group and 2 new recurrences(3.28%)in the PBC group,with no significant difference(P>0.05).Conclusion:Both radiofrequency thermocoagulation and percutaneous balloon compression can effectively treat patients with primary trigeminal neuralgia.Intraoperative balloon compression has more stable hemodynamics.Among them,cheek numbness,decreased masticatory muscle strength,herpes labialis and corneal discomfort are less after radiofrequency thermocoagulation.The recurrence rate of coagulation is higher than that of balloon compression.