A case report and literature review on the use of CT-guided radiofrequency thermocoagulation treatment for Meige syndrome

Background Meige syndrome is a rare extrapyramidal disorder characterized by involuntary blepharospasm, oromandibular dystonia, and cervical muscle contractions, typically affecting middle-aged individuals. While botulinum toxin injections and deep brain stimulation are established treatments, minimally invasive alternatives are needed for patients with contraindications to surgery or anesthesia. This case report describes the first documented application of CT-guided radiofrequency thermocoagulation in China for Meige syndrome, offering a novel therapeutic approach. Case presentation A 59-year-old male welder presented with a 6-year history of progressive blepharospasm, facial grimacing, dysphagia, and photophobia. Symptoms worsened with emotional stress and initially improved with dry eye treatment. Neurological examination revealed bilateral eyelid rigidity, reduced palpebral aperture (3 mm), and absent light reflex in the right eye. Brain MRI showed mild leukoaraiosis, and cervical artery imaging indicated irregular thickening. The patient underwent CT-guided radiofrequency thermocoagulation targeting the stylomastoid foramen. Under local anesthesia, a 22G needle was inserted under CT guidance to deliver thermal energy, achieving successful denervation confirmed by intraoperative muscle response monitoring. Postoperatively, blink frequency decreased from 40/min to 8/min (80% improvement), photophobia reduced from NRS-8 to NRS-2 (75% improvement), and dysphagia resolved (FOIS scale improved from 3 to 6). No complications occurred, and symptoms remained stable at 1-year follow-up. Conclusion This case highlights the feasibility and efficacy of CT-guided radiofrequency thermocoagulation as a minimally invasive alternative for Meige syndrome. By enabling precise neural ablation under real-time imaging guidance, this technique offers symptom relief without systemic anesthesia risks or frequent retreatments required for botulinum toxin. The approach holds promise for improving outcomes in patients with refractory Meige syndrome, particularly those ineligible for surgical interventions. Further studies are warranted to validate long-term efficacy and optimize procedural protocols.