Skip to main content
  • Effectiveness of Repeat Radiofrequency Thermocoagulation in the Treatment of Recurrent Trigeminal Neuralgia

    Final Number:

    Matthew Bender; Gustavo Pradilla MD; Sachin Batra MD, MPH; Alfred Pokmeng See; Neal Bhutiani BS; Carol James BS; Michael Lim MD; Benjamin S. Carson MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Radiofrequency thermocoagulation (RFTC) is routinely used in the treatment of trigeminal neuralgia (TN). Pain relief achieved lasts 3-5 years in most patients after the first treatment but the outcomes of subsequent RFTC interventions have not been sufficiently studied.

    Methods: Between 1998 and 2010, 412 patients with TN underwent 728 RFTC procedures. Outcomes were available for 638 RFTCs (87.6%), 90 RFTCs (12.4%) were excluded due to limited follow-up. Comparisons were made between 502 first and second RFTC (RFTC 1&2) and 136 third or additional RFTCs (RFTC 3+). Pain relief was assessed using the Boulder-Stanford (B-S) pain scale and compared with a Fisher’s exact test. Durability was assessed by determining median time to treatment failure (B-S scale 3 or 4) for all procedures that achieved good pain relief outcomes (B-S 1 or 2, n=510; 315 failures, 195 censored). Predictors of treatment failure were assessed by multivariate Cox-regression analyses adjusting for multiple procedures within same patient.

    Results: Pain relief outcomes after RFTC 1&2 were excellent in 346 (68.9%), moderate in 67 (13.4%), mild in 38 (7.6%), and unchanged in 51 (10.1%), while after RFTC3+ excellent pain relief was achieved in 80 patients (58.8%), moderate in 17 (12.5%), mild in 11 (8.1%), and unchanged in 28 (20.6%) (p = 0.015). Median time to RFTC failure was 513 days in RFTC1&2 (95% CI 440-608) compared with 456 days in RFTC3+ (95% CI 333-552, Chi-square = 0.0163). Prior RFTC and male gender were associated with a 44.5% (HR 1.445, 95% CI 1.094-1.908) and a 27.7% (HR 1.277, 95% CI 1.014-1.607) increase in risk of failure, respectively.

    Conclusions: Pain relief and durability after RFTC significantly decreased in patients undergoing a third or subsequent RFTC as compared with patients undergoing a first or second procedure in the cohort studied. Male gender and previous RFTC were associated with poor pain relief and early treatment failure.

    Patient Care: This study provides further evidence of the efficacy of repeated radiofrequency treatments in patients with recurrent trigeminal neuralgia.

    Learning Objectives: To described the indications for radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. To understand the efficacy of repeated radiofrequency thermocoagulation in patients with recurrent trigeminal neuralgia.


We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy