Efficacy of Gasserian Ganglion High-Voltage, Long-Duration Pulsed Radiofrequency Combined With Block on Acute/Subacute Zoster-Related Trigeminal Neuralgia

Abstract

Background: Trigeminal postherpetic neuralgia (TPHN) is a severe chronic pain that can lead to various socioeconomic consequences. Therefore, it is necessary to explore optimal treatment options for acute/subacute herpes zoster (HZ)-related trigeminal neuralgia and prevent the further development of TPHN. High-voltage, long-duration pulsed radiofrequency (HL-PRF) of the Gasserian ganglion is a new surgical intervention used to treat PHN. A ganglion block has been reported to possess anti-inflammatory effects and potential analgesic benefits. Methods: We included 83 patients with HZ-related acute/subacute trigeminal neuralgia admitted from January 1, 2021, to June 1, 2023, and received Gasserian ganglion HL-PRF combined with block. A 6-month follow-up was conducted, including Numerical Rating Scale (NRS) scores, Pittsburgh Sleep Quality Index (PSQI), the incidence of TPHN, the dosage of anticonvulsants and analgesics, efficacy, and adverse events. Results: All patients showed a significant decrease in postoperative NRS scores (p < 0.05). The NRS scores of the acute HZ group were consistently lower than those of the subacute HZ group at different time points (p < 0.01). The overall incidence of TPHN from the onset of HZ to 12 weeks is 21.68%. The incidence of TPHN in the acute phase group was 12.77%, significantly lower than the 33.33% in the subacute phase group (p=0.024). The effective rate was 74.7% in all patients, at 3 months after the treatment. The effective rate was 82.98% in the acute phase group and 63.89% in the subacute phase group, showing a statistically significant difference (p=0.047). The PSQI score of the acute group was consistently lower than that of the subacute group (p < 0.01). The dosage of analgesics and anticonvulsants used in the acute HZ group was lower than that in the subacute group (p < 0.01). All patients did not experience serious adverse reactions. Conclusions: Gasserian ganglion HL-PRF combined with block can be an effective and safe technique to relieve the pain of acute/subacute zoster-related trigeminal neuralgia and prevent the incidence of TPHN.

Keywords: Gasserian ganglion; acute; block; high-voltage; long-duration; pulsed radiofrequency; subacute; trigeminal neuralgia.

Figure 1

The surgical process of pulsed radiofrequency. (a) Adjust the appropriate angle of the fallopian tube to expose the foramen ovale, and puncture it into the foramen ovale with a radiofrequency needle under X-ray guidance. (b) Display the depth reached by the radiofrequency needle tip under lateral X-ray fluoroscopy.

Figure 2

Radiofrequency instrument parameters during surgery.

Figure 3

Postoperative NRS scores at each follow-up time point in all patients. Compared with baseline, ^#p < 0.05.

Figure 4

The comparison of postoperative NRS scores at each follow-up time point in two groups. Compared with the acute zoster group, ^∗p < 0.01.

Figure 5

Postoperative PSQI scores at each follow-up time point in all patients. Compared with baseline, ^#p < 0.05.

Figure 6

The comparison of postoperative PSQI scores at each follow-up time point in two groups. Compared with the acute zoster group, ^∗p < 0.01.

Figure 7

Postoperative dosage of pregabalin at each follow-up time point in all patients. Compared with baseline, ^#p < 0.05 and ^∗p < 0.01.

Figure 8

Postoperative dosage of tramadol at each follow-up time point in all patients. Compared with baseline, ^#p < 0.05.

Figure 9

The comparison of postoperative dosage of pregabalin at each follow-up time point in two groups. Compared with the acute zoster group, ^∗p < 0.01.

Figure 10

The comparison of postoperative dosage of tramadol at each follow-up time point in two groups. Compared with the acute zoster group, ^∗p < 0.01.