• Dimitrios K Filippiadis, Dionysios Markoutsas, Argyro Mazioti, Grigorios Tsoukalos, Olympia Papakonstantinou, Panteleimon Stamatis, Alexis Kelekis, and Dimitrios Tzavoulis.
• Second Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Athens, Greece.
• Pain Physician. 2020 Jun 1; 23 (3): 293-298.

BackgroundTrigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%.ObjectivesTo report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN.Study DesignRetrospective institutional database review; bicentral study.SettingAlthough this was a retrospective database research, institutional review board approval was obtained.MethodsInstitutional database review identified 10 patients (men 8, women 2) who underwent CT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examination and magnetic resonance imaging. Under anesthesiology control and local sterility measures, a radiofrequency needle was advanced, and its approach was evaluated with sequential CT scans. Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week, 1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire.ResultsMean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week after the RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and 6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370 units, respectively. There were no postoperative complications. Three patients experienced facial numbness, which gradually resolved over a period of 1 month.LimitationsRetrospective nature; small number of patients; lack of a control group undergoing a different treatment of TN.ConclusionsPercutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe and efficacious technique for the treatment of TN, with significant pain relief and minimal complication rates improving life quality in this group of patients.Key WordsTrigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computed tomography, imaging.

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