Abstract / Summary
Abstract Introduction Trigeminal neuralgia (TN) is a severe neuropathic pain disorder for which radiofrequency thermocoagulation (RFT) is an established percutaneous treatment. Coblation, or low-temperature plasma radiofrequency ablation (LTP-RFA), has been proposed as an alternative that may reduce collateral thermal injury and postoperative sensory disturbance. This systematic review and meta-analysis compared the efficacy and safety of coblation with RFT for TN. Methods MEDLINE via PubMed, Embase, CINAHL, Web of Science and CENTRAL were searched from inception to 14 August 2026. Randomised and comparative observational studies directly comparing coblation/LTP-RFA with RFT were eligible. Primary outcomes were pain relief, postoperative facial numbness and recurrence. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle–Ottawa Scale (NOS) for comparative observational studies. Random-effects meta-analysis was restricted to clinically comparable outcomes and time points where participant duplication could reasonably be avoided. Certainty of evidence was assessed using GRADE. Results Four comparative studies were included: two randomised studies and two retrospective cohorts. All originated from the same institution, with overlapping recruitment periods raising concern about possible participant duplication, particularly between the retrospective cohorts. Primary quantitative synthesis was therefore restricted to the randomised studies. LTP-RFA was associated with lower odds of early postoperative facial numbness compared with RFT (OR 0.36, 95% CI 0.18–0.72; I²=0%; 2 RCTs, 254 participants) and facial numbness at 6 months (OR 0.20, 95% CI 0.07–0.54; I²=53%; 2 RCTs, 254 participants). Pain relief was broadly comparable. In the larger randomised non-inferiority trial, initial efficacy was 91.2% with LTP-RFA versus 93.1% with RFT, and 6-month efficacy was 83.3% versus 87.3%, respectively. Observational findings were directionally consistent but were not pooled because of probable cohort overlap. Conclusion Coblation/LTP-RFA and RFT both provide substantial short-term pain relief. Randomised evidence suggests a signal towards less postoperative facial numbness with coblation, but certainty remains limited by the small number of trials, single-centre evidence, imprecision and limited long-term follow-up. These findings are trial-informing rather than practice-changing.