The Role of Radiofrequency Thermocoagulation
- 334 Downloads
Conventional (Continuous) Radiofrequency thermocoagulation (CRF) and pulsed radiofrequency (PRF) are becoming treatment choices in severe headache cases. PRF differs from CRF as it maintains tissue temperature below 42 °C and prevents possible tissue destruction. We will focus on the PRF technique, mechanisms, and usage in cases of headache resistant to medical treatment. Its usage in trigeminal neuralgia is well known. We will therefore concentrate on the effectiveness of PRF of the sphenopalatine ganglion (SPG) in a resistant cluster headache patient, PRF of the greater occipital nerve (GON) in a cervicogenic headache patient, and PRF of the lesser occipital nerve (LON) in LON neuralgia.
Nerve stimulation is necessary before making an RF lesion. Fluoroscopy, ultrasound, or CT-guided needle placement may be used. The place of the needle should be checked with nerve stimulation. The needle should be replaced under guidance if it is not at the correct localization as determined by the stimulation response.
The mechanism of the analgesic effect of PRF is not well known. These changes take days to develop after the application of PRF and are not related to the temperature.
KeywordsInterventional management Headache Radiofrequency
- 1.Cosman ER Sr, Cosman ER Jr. Principles and descriptions of special techniques. In: Raj PP, Erdine S, editors. Pain relieving procedures. The illustrated guide. Chichester: Wiley-Blackwell; 2012. p. 68–91.Google Scholar
- 2.Cosman E, Cosman B. Methods of making nervous system lesion. In: Wilkens R, Rengachary SS, editors. Neurosurgery. New York: McGraw-Hill; 1984. p. 2490–9.Google Scholar
- 3.Van Zundert J, Sluijter M, Van Kleef M. Thermal and pulsed radiofrequency. In: Raj PP, Lou L, Erdine S, Staats PS, Waldman SD, Racz G, Hammer M, Niv D, Lopez RR, Heavner JE, editors. Interventional pain management image-guided procedures. Philadelphia: Saunders Elsevier; 2008. p. 56–65.Google Scholar
- 5.Sluijter ME, Cosman ER, Rittman WB II, Van Kleef M. The effects of pulsed radiofrequency field applied to the dorsal root ganglion: a preliminary report. Pain Clinic. 1998;11:109–17.Google Scholar
- 16.Cohen SP, Peterlin BL, Fulton L, Neely ET, Kurihara C, Gupta A, Mali J, Fu DC, Jacobs MB, Plunkett AR, Verdun AJ, Stojanovic MP, Hanling S, Constantinescu O, White RL, McLean BC, Pasquina PF, Zhao Z. Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness. Pain. 2015;156(12):2585–94.CrossRefGoogle Scholar