Association between intraoperative parameters and pain reduction after radiofrequency rhizotomy in patients with trigeminal neuralgia.
CSF outflow during rhizotomy is linked to greater long-term pain relief in trigeminal neuralgia.
Association between intraoperative parameters and pain reduction after radiofrequency rhizotomy in patients with trigeminal neuralgia.
Percutaneous radiofrequency (radiofrequency) rhizotomy is one of the most effective minimally invasive treatments for trigeminal neuralgia (trigeminal neuralgia) that is unresponsive to medication.
This study aimed to evaluate the relationship between these procedural factors and postoperative pain reduction.
A retrospective analysis of a prospectively maintained database was performed of patients who underwent percutaneous radiofrequency rhizotomy for trigeminal neuralgia at a single tertiary facility from February 2019 to December 2023.
Univariate analysis indicated that CSF outflow was a significant predictor of treatment success (p < 0.001), while higher prelesion impedance, longer lesioning durations, and greater thermal dose were associated with lower odds of success.
In multivariate models, CSF outflow and prelesion impedance were the most significant independent predictors of achieving a Barrow Neurological Institute score ≤ IIIa at the final follow-up.
Temperature-by-time summation outperformed CEM43 in predicting outcomes, suggesting that prolonged lesioning reflects technical difficulty rather than therapeutic benefit.
CSF outflow and low prelesion impedance were the most reliable intraoperative markers of effective percutaneous radiofrequency for trigeminal neuralgia, likely indicating accurate electrode placement within the trigeminal cistern and optimal electrical coupling.
Conversely, longer lesion durations and increased cumulative thermal exposure did not improve outcomes, highlighting that accurate positioning, rather than aggressive lesioning, is key to achieving long-lasting pain relief.