Percutaneous radiofrequency thermocoagulation in treating idiopathic trigeminal neuralgia in elderly patients: insights from yemen's sole center in sana'a City.

BACKGROUND

Trigeminal neuralgia (TN) is a severely painful condition that is challenging to treat effectively. For patients who do not respond well to oral medications, percutaneous radiofrequency thermocoagulation (PRT) has emerged as a safe and minimally invasive procedure for treating TN. This study aimed to assess the safety and effectiveness of PRT in treating elderly patients with ITN.

METHODS

A prospective cohort study was conducted among 134 elderly patients with ITN subjected to PRT at the Pioneer Medical Center for Neurosurgery and Pain Management in Sana'a city, Yemen, from September 2022 to October 2024. PRT was performed by foramen ovale puncture, and repeat PRT was conducted for all patients with recurrent pain. The Barrow Neurological Institute (BNI) pain intensity scale was used to assess the degree of pain after PRT. The outcome was considered successful if the patient's BNI score decreased to I-IIIb or failed if a patient's BNI pain score was IV or V. Recurrence of pain and complications were also recorded. Data about the safety and effectiveness of PRT were then summarized using descriptive statistics.

RESULTS

PRT was successful in 125 of 134 patients (93.3%), with 95 patients (71.4%) achieving complete pain relief (BNI score I) and 30 patients (22.4%) achieving adequate pain control (BNI scores II-IIIb). Pain recurrence was observed in 27 patients (20.1%) within two years, and repeat PRT was successful in all recurrent cases, with 19 patients (70.4%) achieving complete pain relief. Complications were minimal, with intrabuccal hematoma being the most common (4.5%) and dysesthesia the least common (1.5%).

CONCLUSION

PRT is a highly effective and safe treatment for elderly patients with ITN in Yemen, achieving an immediate success rate of over 90% in pain relief. While pain recurrence is a notable concern, repeat PRT proves to be a reliable solution for managing recurrent pain. PRT is associated with a low rate of mild and transient complications, but long-term monitoring and follow-up for recurrence and complications are essential to optimize outcomes.