Peripheral Branch Radiofrequency Thermocoagulation for Primary V2 Trigeminal Neuralgia: A Retrospective Cohort Study Guided by Diagnostic Nerve Blocks.

objectiveTo evaluate the clinical outcomes and safety of two peripheral branch radiofrequency thermocoagulation techniques-infraorbital nerve radiofrequency thermocoagulation (ION-RFT) and maxillary nerve radiofrequency thermocoagulation (MN-RFT)-guided by diagnostic block responses in a retrospective cohort of patients with primary V2 trigeminal neuralgia (TN), and to assess perioperative outcomes, including operative time, hospital stay, and healthcare costs, within this treatment pathway.

methodsThis retrospective study included 92 patients with primary V2 TN treated at Nanjing Drum Tower Hospital between April 2021 and April 2024. All diagnostic nerve blocks were performed in the outpatient setting prior to hospital admission. Based on the diagnostic block responses, patients were divided into two groups: those who responded positively to the infraorbital nerve block received ION-RFT, n = 45, and those who did not respond to the infraorbital block but subsequently responded to the maxillary nerve block received MN-RFT, n = 47. Pain intensity was assessed using the visual analog scale (VAS) at baseline and at 1, 3, 6, and 12 months posttreatment. Recurrence rates were recorded at the same follow-up intervals. Operative time was extracted from surgical records. Hospital stay, total healthcare costs, and complications were evaluated at the time of discharge.

resultsBoth treatment modalities resulted in significant postoperative pain reduction compared with baseline (within-group effect, both p < 0.001). The incidence of postoperative complications and recurrence rates at all follow-up time points did not differ significantly between the two groups (all p > 0.05). In terms of perioperative metrics, patients undergoing ION-RFT had significantly shorter operative time (30.020 ± 11.957 min vs. 35.660 ± 10.602 min, p = 0.019) and shorter hospital stay (2.130 ± 1.200 days vs. 2.790 ± 1.610 days, p = 0.030) compared with those undergoing MN-RFT, while total healthcare costs did not differ significantly between the two groups (5086.770 ± 1246.540 Yuan vs. 4988.250 ± 1144.350 Yuan, p = 0.694). Regarding pain outcomes, VAS scores in the ION-RFT group showed a gradual increase from the immediate postoperative period to the 6-month follow-up, while scores in the MN-RFT group remained relatively stable during this period (approach × time interaction, F = 4.000, p = 0.019); however, the difference in VAS scores between the two groups at 6 months did not reach statistical significance (p = 0.057).

conclusionIn patients with primary V2 TN, diagnostic block-guided selection of ION-RFT or MN-RFT is a safe and viable treatment. Both techniques offer comparable pain relief, complications, and recurrence rates. ION-RFT provides shorter operative time and hospital stay, reflecting faster recovery, while healthcare costs are similar between groups. These findings support a diagnostic block-guided strategy that enables appropriately selected patients to receive a less invasive procedure without compromising efficacy.