Skip to main content
SpringerLink
Log in
Book cover

Handbook of Trigeminal Neuralgia pp 141–150Cite as

Radiofrequency Thermocoagulation for Trigeminal Neuralgia

  • Chapter
  • First Online:

  • 1180 Accesses

Abstract

Trigeminal neuralgia (TGN) can be managed medically, surgically, or by percutaneous techniques. Among the percutaneous techniques, radiofrequency thermocoagulation (RFT) offers many benefits over others. The radiofrequency (RF) current is a low energy, high frequency (50–500 kHz), alternate current. When RF current is delivered to the biological tissues, it causes oscillation of the molecules within the tissue. That leads to production of heat by friction between the oscillating particles [1]. A lesion is formed if the temperature within the neuronal tissue exceeds 40 °C [2]. Two different modalities of RF currents are commonly practiced in interventional pain medicine: (1) Continuous radiofrequency (CRF) and (2) Pulsed radiofrequency (PRF). In CRF, an alternate current in the frequency range of 100–500 kHz is applied continuously to a target nerve; the aim is to produce a thermal lesion thereby causing interruption of afferent pathways for nociception [1]. The thermal (Heat) energy is produced transversely along the active tip of the electrode. Hence, an alignment of the active tip is usually desired alongside of the nerve targeted, and not perpendicular to it [3]. In PRF, an alternate current is applied to the target nerve without generating significant heat. Typically, high frequency current of 50 kHz is delivered over 20 ms pulses at a frequency of 2 Hz, for a duration of 120 s. The long pause between pulses results in heat dissipation, thereby keeping tissue temperature below neuro-destructive threshold of 45 °C. Pulsing the current also allows the generator power output to be substantially increased. The usual voltage output in CRF is 15–25 V, while PRF is usually carried out at 45 V. Heating is further minimized by restricting electrode tip temperature below 42 °C. Thus, the low temperature in the tissues is insufficient to produce neural lesion. In contrast to CRF, the distal active tip is desired to be perpendicular to the target nerve in PRF, as it allows delivery of highest intensity with such a placement [1].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Rea W, Kapur S, Mutagi H. Radiofrequency therapies in chronic pain. Contin Educ Anaesth Crit Care Pain. 2011;11:35–8.

    Article  Google Scholar 

  2. Slappendel R, Crul B, Braak GJ, Geurts JW, Booji LH, Voerman VF, de Boo T. The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blind randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain. 1997;73:159–63.

    Article  CAS  Google Scholar 

  3. Lord SM, Bagduk N. Radiofrequency procedures in chronic pain. Best Pract Res Clin Anesthesiol. 2002;16:597–617.

    Article  Google Scholar 

  4. Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. J Neurosurg. 1974;40:143–56.

    Article  CAS  Google Scholar 

  5. Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic. Trigeminal neuralgia: 25 years’ experience with 1600 patients. Neurosurgery. 2001;48:532–4.

    Google Scholar 

  6. Emril DR, Ho K. Treatment of trigeminal neuralgia: role of radiofrequency ablation. J Pain Res. 2010;3:249–54.

    PubMed  PubMed Central  Google Scholar 

  7. Wang JY, Dender MT, Bettegowda C. Percutaneous procedures for the treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2016;27:277–95.

    Article  Google Scholar 

  8. Raj PP, Lou L Erdine S, Staats PS, Waldman SD, editors. Radiographic imaging for regional anesthesia and pain management. Philadelphia PA: Churchill Livingstone; 2003.

    Google Scholar 

  9. Koizuka S, Saito S, Kubo K, Tomioka A, Takazawa T, Sakurazawa S, Goto F. Percutaneous radiofrequency mandibular nerve rhizotomy guided by CT fluoroscopy. AJNR. 2006;27:1647–8.

    CAS  PubMed  Google Scholar 

  10. Tang YZ, Wu BS, Yang LQ, Yue JN, He LL, Li N, et al. The long term effective rate of different branches of idiopathic trigeminal neuralgia after single radiofrequency thermocoagulation. Medicine (Baltimore). 2015;94:e1994.

    Article  Google Scholar 

  11. Nie F, Su D, Shi Y, Chen J, Wang H, Chen Y, et al. A prospective study of x-ray imaging combined with skin stimulation potential- guided percutaneous continuous radiofrequency thermocoagulation of the Gasserian ganglion for the treatment of trigeminal neuralgia. Pain Med. 2014;15:1464–9.

    Article  Google Scholar 

  12. Hart MG, Nowell M, Coakham HB. Radiofrequency thermocoagulation for trigeminal neuralgia without intraoperative patient waking. Br J Neurosurg. 2012;392:110–5.

    Google Scholar 

  13. Patil AA, Chamczuk AJ, Nelson B. Stereotactic radiofrequency ablation of trigeminal ganglion with intraoperative CT scan and under general anesthesia. Open J Modern Neurosurg. 2016;6:55–9.

    Article  Google Scholar 

  14. Kosugi S, Shiotani M, Otsuka Y, Suzuki T, Kotari N, Hashguchi S, Morisaki H. Long term outcomes of percutaneous radiofrequency thermocoagulation of Gasserian ganglion for 2nd and multiple-division trigeminal neuralgia. Pain Pract. 2015;15:223–8.

    Article  Google Scholar 

  15. Fraioli B, Epsosito V, Guidetti B, Cruccu G, Manfredi M. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization and percutaneous compression of the Gasserian ganglion and/or retrogasserian rootlets: long term results and therapeutic protocols. Neurosurgery. 1989;24:239–45.

    Article  CAS  Google Scholar 

  16. Finch PM. A curved approach to nerve blocks and radiofrequency lesioning. Pain Digest. 1997;7:251–7.

    Google Scholar 

  17. Tobler WD, Tew JM Jr, Cosman E, Keller JT, Quallen B. Improved outcome in the treatment of trigeminal neuralgia by percutaneous stereotactic rhizotomy with a new, curved tip electrode. Neurosurgery. 1983;12:313–7.

    Article  CAS  Google Scholar 

  18. Laghmari M, El Ouahahi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia. Surg Neurol. 2007;68:505–12.

    Article  Google Scholar 

  19. Jin HS, Shin JY, Kim YC, Lee SC, Choi EJ, Lee PB, Moon JY. Predictive factors associated with success and failure for radiofrequency thermocoagulation in patients with trigeminal neuralgia. Pain Physician. 2015;18:537–45.

    PubMed  Google Scholar 

  20. Yizhong H, Jiaxiang NI, Baishan WU, Mingwei HE, Liqiang Y, Wang Q. Percutaneous radiofrequency thermocoagulation for the treatment of different types of trigeminal neuralgias: evaluation of quality of life and outcomes. J Huazhong Univ Sci Technolog Med Sci. 2010;30:403–7.

    Article  Google Scholar 

  21. Sindou M, Tatli M. Treatment of trigeminal neuralgia with thermocoagulation. Neurochirurgia. 2009;55:203–10.

    Article  CAS  Google Scholar 

  22. Bender MT, Pradilla G, Batra S, See AP, James C, Prado CA, et al. Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis. J Neurosurg. 2013;118:329–36.

    Article  CAS  Google Scholar 

  23. Bogduk N. Pulsed radiofrequency. Pain Med. 2006;7:396–407.

    Article  Google Scholar 

  24. Li X, Ni J, Yang L, Wu B, He M, Zhang X, Ma L, Sun H. A prospective study of Gasserian ganglion pulsed radiofrequency with continuous radiofrequency for the treatment of trigeminal neuralgia. J Clin Neurosci. 2012;19:824–8.

    Article  CAS  Google Scholar 

  25. Zhao WX, Wang Q, He MW, Yang B, Wu S, Ni JX. Radiofrequency thermocoagulation combined with pulsed radiofrequency helps relieve postoperative complications of trigeminal neuralgia. Genet Mol Res. 2015;14:7616–23.

    Article  Google Scholar 

  26. Luo F, Meng L, Wang T, Yu X, Shen Y, Ji N. Pulsed radiofrequency treatment for idiopathic trigeminal neuralgia: a retrospective analysis of the causes for ineffective pain relief. Eur J Pain. 2013;17:1189–92.

    Article  CAS  Google Scholar 

  27. Liao C, Visocchi M, Liu P, Zhang W. Pulsed radiofrequency: a management option for recurrent trigeminal neuralgia following radiofrequency thermocoagulation. World Neurosurg. 2017;97:760.e5–7.

    Article  Google Scholar 

  28. Meng Q, Zhang W, Yang Y, Zhou M, Li X. Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia. J Neurosurg Anesthesiol. 2008;20:131–5.

    Article  Google Scholar 

  29. Rath G, Dash HH, Bithal PK, Goyal V. Intracranial hemorrhage after percutaneous trigeminal rhizotomy. Pain Pract. 2009;9:82–4.

    Article  Google Scholar 

  30. Ward L, Khan M, Greig M, Dolin SJ. Meningitis after percutaneous radiofrequency trigeminal ganglion lesion. Case report and review of literature. Pain Med. 2007;8:535–8.

    Article  Google Scholar 

  31. Yang Y, Shao Y, Wang H, Liu Y, Zhu S, Wu C. Neuronavigation assisted percutaneous thermocoagulation in trigeminal neuralgia. Clin J Pain. 2007;23:159–64.

    Article  Google Scholar 

  32. Guo Z, Wu B, Du C, Cheng H, Tian Y. Stereotactic approach combined with 3D CT reconstruction for difficult to access foramen ovale on radiofrequency thermocoagulation of the Gasserian ganglion for trigeminal neuralgia. Pain Med. 2016;17:1704–16.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neuroanesthesiology, Department of Anesthesiology and OR Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia

    Parmod Kumar Bithal

Authors
  1. Parmod Kumar Bithal
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

    Girija Prasad Rath

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bithal, P.K. (2019). Radiofrequency Thermocoagulation for Trigeminal Neuralgia. In: Rath, G. (eds) Handbook of Trigeminal Neuralgia. Springer, Singapore. https://doi.org/10.1007/978-981-13-2333-1_19

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-2333-1_19

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-2332-4

  • Online ISBN: 978-981-13-2333-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation