J Neurosurg 143:100–110, 2025
High-voltage pulsed radiofrequency (PRF) combined with low-temperature continuous radiofrequency (CRF) significantly improved 12-month response rates and pain scores in primary trigeminal neuralgia compared to PRF alone, with minimal complications. This combined approach offers a promising alternative for patients unresponsive to medication.
High-voltage pulsed radiofrequency (PRF) combined with low-temperature (60°C) continuous radiofrequency (CRF) was compared to high-voltage PRF alone for treating primary trigeminal neuralgia (TN) in a randomized controlled trial.
• 146 patients were randomized to either PRF+CRF or PRF alone, with 12-month response rate as the primary outcome.
• The PRF+CRF group had a significantly higher response rate at 12 months (83.6% vs 67.1%, p = 0.021) and better pain relief at all measured time points.
• Patient satisfaction scores were higher in the PRF+CRF group at 1, 6, and 12 months.
• Facial numbness and masseter muscle weakness were more frequent in the PRF+CRF group but were mild and resolved within months; no serious complications occurred.
• Both treatments were safe, with no cases of anesthesia dolorosa, corneal anesthesia, or keratitis.
• The study was limited by single-center design, open-label nature, and a smaller than expected difference in primary outcome, suggesting the need for larger studies.
• Conclusion: High-voltage PRF combined with low-temperature CRF offers better pain control and satisfaction than PRF alone, with minimal side effects, for patients with refractory TN.
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