Long-term effects of conventional radiofrequency in cases of trigeminal neuralgia

Year 2024, , 212 - 214, 30.09.2024

Ahmet Yılmaz

https://doi.org/10.36516/jocass.1531243

Abstract

Objective: Trigeminal neuralgia (TN) is defined as severe, episodic pain occurring in one or more branches of the trigeminal nerve. Due to its long-term effect, radiofrequency thermocoagulation (RFT) is used as a first-line treatment. The first choice in the treatment of classical trigeminal neuralgia patients is medical treatment. Additionally, pregabalin and gabapentin are frequently used drugs. Surgical treatment is an option for Trigeminal Neuralgia that cannot be treated with medication, but there is no single method for this. Various surgical methods, such as Trigeminal Radiofrequency (RF) rhizotomy may be effective in treatment.
Material and metods: The procedure is performed under operating room conditions and radiological imaging guidance. The patient is placed in the supine position, an IV line is established, and monitoring is initiated. After local field cleaning and sterile draping, optimal imaging is achieved using C-arm fluoroscopy with an ipsilateral 15° oblique and 30° caudal angle. A 22-gauge, 100 mm RF needle with a 5 mm active tip is directed towards the foramen ovale, and the tunnel view is checked.
Results: In our study, the minimum age was 41 and the maximum age was 68. Additionally, 9 of the patients were female, and 2 were male. In our series, 9 patients had mandibular nerve involvement, and 2 had maxillary nerve involvement. In our series, 6 patients were using carbamazepine, 4 were using pregabalin, and 1 was using gabapentin. Medication treatment was discontinued in all patients after the procedure. As shown in Table 1, the VAS score decreased to 0 in 6 patients on the 15th day, to 2 in 4 patients, and to 1 in 1 patient. The VAS score exceeded 5 in 1 patient in the 2nd year and in 5 patients in the 4th year, and conventional RFT was repeated for these patients. The VAS score decreased to 0 in 6 patients on the 15th day, to 2 in 4 patients, and to 1 in 1 patient. The VAS score exceeded 5 in 1 patient in the 2nd year and in 5 patients in the 4th year, and conventional RFT was repeated for these patients. Pregabalin 75 mg was started for all patients between the recurrence of pain and the interventional procedure, and it was discontinued once the pain decreased after the procedure. No side effects were observed in the patients.
Conclusion: The treatment of trigeminal neuralgia includes medical, surgical, and percutaneous interventional options. Conventional RF thermocoagulation is the first choice among other percutaneous interventional and surgical treatment options in TN treatment due to its selective lesion formation, minimally invasive nature, high success rate, low complication rate, and low cost.

Keywords

trigeminal neuralgia, conventional radiofrequency, fasial pain

References

• 1.International Association for the Study of Pain (IASP): Classification of chronic pain. Descriptors of chronic pain syndromes and definitions of pain terms. 2nd edition. IASP Press, Washington, DC, 1994.
• 2.Zakrzewska JM, McMillan R. Trigeminal neuralgia: The diagnosis and man¬agement of this excruciating and poorly understood facial pain. Postgrad Med. J 2011:87:410. https://doi.org/10.1136/pgmj.2009.080473
• 3.Zakrzewska JM, Lopez BC, Kim SE and Coakham HB. Patient reports of sat¬isfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia. Neurosurgery. 2015:56:1304-11. https://doi.org/10.1227/01.NEU.0000159883.35957.E0
• 4.Devor M, Amir R, Rappaport ZH: Pathophysiology of trigeminal neuralgia: The ignition hypothesis. Clinical Journal of Pain 18: 4-13, 2002 https://doi.org/10.1097/00002508-200201000-00002
• 5.Savaş A. Trigeminal Nevralji Tedavisinde RF Rizotomi, Türk Nöroşir Derg. 2019:29:140-6.
• 6.Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal gan-glion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia. J Neurosurg. 1974:40:143-156. https://doi.org/10.3171/jns.1974.40.2.0143
• 7.Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal gan-glion and rootlets for diff erential destruction of pain fibers: Part 1-Trigemi¬nal neuralgia. J Neurosurg. 1974: 39: 143-56. https://doi.org/10.3171/jns.1974.40.2.0143
• 8.Nugent GR: Radiofrequency treatment of trigeminal neuralgia using a cor¬dotomy-type electrode: A method. Neurosurg Clin N Am. 1997: 8: 41-51. https://doi.org/10.1016/S1042-3680(18)30336-X
• 9.Kanpolat Y, Savas A, Ugur HA, et al. The trigeminal tract and nucleus pro-cedures in treatment of atypical facial pain. Surg Neurol. 2005; 64: 96-101. https://doi.org/10.1016/j.surneu.2005.07.018
• 10.Erdine S, Ozyalcin NS, Cimen A, et al. Comparison of pulsed radiofre-quency with conventional radiofrequency in the treatment of idiopathic tri¬geminal neuralgia. Eur J Pain. 2007; 11:309-13. https://doi.org/10.1016/j.ejpain.2006.04.001
• 11.Can E, Perdecioğlu G, Yıldız G, et al. Evaluation of the efficacy of ultra-sound-guided maxillary and mandibular nerve pulsed radiofrequency treat¬ment for trigeminal neuralgia and factors associated with successful re¬sponse: a retrospective study. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-024-02638-2
• 12.Mansano A. Percutaneous radiofrequency ablation for trigeminal neural¬gia management: a randomized, double-blinded, sham-controlled clinical trial. Pain Medicine, 2023;3:234-23. https://doi.org/10.1093/pm/pnac132
• 13.Eskandar, E. The role of radiofrequency ablation in the treatment of tri-geminal neuralgia: a narrative review. Cureus. 2023;15:3. https://doi.org/10.7759%2Fcureus.36193
• 14.Küçükbingöz Ç, Marufoglu F, Bayram T, et al. Investigation of the Effects of Pulsed Radiofrequency Application of the Thoracal Dorsal Root Ganglion on Postherpetic Neuralgia and Post-thoracotomy Pain Syndromes. Journal of Cukurova Anesthesia and Surgical Sciences, 6(2), 262-6. https://doi.org/10.36516/jocass.1299024