From Cannulation to Relief: Efficacy of H-figure Fluoroscopic Landmark-Guided Radiofrequency in Trigeminal Neuralgia

Abstract

Objective:  A retrospective case series to evaluate the clinical efficacy, safety profile, and technical feasibility of percutaneous radiofrequency rhizotomy (RFR) using the H-figure fluoroscopic landmark for foramen ovale access in trigeminal neuralgia (TN).

Materials & Methods:  This retrospective case series included 37 patients diagnosed with trigeminal neuralgia (TN) who underwent RFR at Sir Ganga Ram Hospital and Jinnah Hospital, Lahore. The foramen ovale was accessed using H-figure fluoroscopic guidance. Sensory and motor stimulation confirmed electrode placement. Pain intensity was recorded using the Barrow Neurological Institute (BNI) pain scale at baseline, postoperative day 1, and 1-month follow-up. Cannulation success, complications, and recurrence were also evaluated.

Results:  Of 37 patients, 9 (24.3%) were male and 28 (75.7%) were female, with a mean age of 54.84 ± 12.2 years. Left-sided pain was present in about fifty percent of patients (51.4%). The most affected branch was V2 (48.6%), followed by V3 (24.3%), V2+V3 (18.9%), and V1+V2+V3 (8.1%). Foramen ovale cannulation was successful in 91.9% of cases. Median BNI score improved from 4.0 (IQR 4.0–5.0) preoperatively to 2.0 (IQR 1.0–2.0) on day 1, and 1.0 (IQR 1.0–1.0) at 1 month (p < 0.001). Complications occurred in 6 patients (16.2%), most commonly transient V1 numbness. Four patients (10.8%) experienced recurrence within 18 months.

Conclusion:  RFR using the H-figure Fluoroscopic Landmark is an effective technique for trigeminal neuralgia management, providing high rates of pain relief with minimal recurrence and reduced pain intensity in recurrent cases.