Peripheral Pulsed Radiofrequency for Trigeminal Neuralgia: Early Efficacy with Limited Durability in a Real-World Cohort

Background/Objectives: Peripheral pulsed radiofrequency (PRF) is a minimally invasive option for trigeminal neuralgia (TN) with a favorable safety profile compared with neurorestorative techniques, but its durability and recurrence patterns remain uncertain. This study evaluated the early effectiveness, durability, recurrence-free survival, and safety of peripheral PRF in refractory classical or idiopathic TN. Methods: This retrospective single-center cohort study assessed procedure-level outcomes of peripheral PRF targeting the ophthalmic, maxillary, and mandibular branches. Pain intensity and clinical status were evaluated using the Numeric Rating Scale (NRS) and Barrow Neurological Institute (BNI) pain score. Early effectiveness was defined as clinically meaningful pain relief sustained for at least 1 month, and sustained effectiveness as NRS ≤ 3 at 6 months. Recurrence-free survival was analyzed using Kaplan–Meier methods. Results: A total of 68 procedures in 57 patients were analyzed. Early effectiveness at 1 month was achieved in 85.3% of procedures. Median NRS decreased from 9 (IQR 8–9) at baseline to 2 (0–4) at 1 month and 0 (0–2) at 3 and 6 months (p < 0.001). In a worst-case analysis, 6-month sustained effectiveness was 72.1%. Recurrence occurred in 61.8% of procedures, with a median recurrence-free survival of 11 months. Among procedures with recurrence, repeat peripheral PRF was performed in 45.2%. Medication requirements decreased in 66.2% of procedures, and no major complications occurred. Conclusions: Peripheral PRF provides rapid and meaningful early pain relief in TN, but durability is limited. These findings support peripheral PRF as a safe, repeatable neuromodulatory intervention within a staged treatment strategy rather than a definitive therapy.