Clinical predictors of treatment success following Gasserian ganglion conventional radiofrequency in trigeminal neuralgia: secondary cohort analysis

Abstract

Background: The study aimed to identify clinical predictors associated with treatment success following Gasserian ganglion conventional radiofrequency (CRF) in patients with trigeminal neuralgia (TN), with particular focus on the predictive value of early clinical response. Methods: This retrospective secondary cohort analysis included 37 patients with classical TN who underwent Gasserian ganglion CRF at a tertiary pain clinic. Treatment success was defined as a ≥50% reduction in Numerical Rating Scale (NRS) score at 6 months compared with baseline. Demographic characteristics, baseline pain severity, trigeminal branch involvement, early post-procedural pain response, complications, additional treatment requirements, and patient satisfaction scores were analyzed. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performance of early pain reduction for 6-month treatment success. Results: Twenty-nine patients (78.4%) achieved treatment success at 6 months. The success group demonstrated significantly higher median age (67 vs. 54.5 years, p = 0.006) and baseline pain intensity (NRS0: 10 vs. 8, p = 0.007) compared with the non-success group. Early treatment response at 1 month was strongly associated with 6-month success. Median percentage reduction in NRS score at 1 month was significantly greater in the success group (60% vs. 31.25%, p = 0.008). Achieving ≥50% pain reduction at 1 month was significantly associated with treatment success at 6 months (p = 0.0005). ROC analysis demonstrated good predictive performance for early pain reduction (area under the curve (AUC) = 0.804), with a sensitivity of 82.8%and specificity of 87.5% for the ≥50% cutoff. Patient satisfaction scores were higher among patients with treatment success (p < 0.001). Conclusions: Early post-procedural pain reduction appears to be a clinically useful marker of sustained mid-term treatment success after Gasserian ganglion CRF in TN. In particular, a ≥50% reduction in NRS score at 1 month may help identify patients likely to maintain meaningful pain relief at 6 months.