Trigeminal Neuralgia

Trigeminal neuralgia, often termed "suicidal pain," is recognized as one of the most excruciating conditions known to humanity. The pain, typically episodic and severe, is likened to a sharp, shooting sensation or an electric shock in the face, jaw, teeth, or gums. Simple activities such as eating, speaking, or touching the face can trigger this debilitating pain.

The treatment for trigeminal neuralgia encompasses medications, interventions, and open surgery, with this article focusing specifically on interventions. Radiofrequency thermocoagulation presents a minimally invasive interventional option for trigeminal neuralgia, particularly when medications prove ineffective or cause intolerable side effects. It is also considered when microvascular decompression (MVD), a more invasive surgical procedure, is deemed unsuitable for the patient.

The radiofrequency thermocoagulation procedure is conducted with meticulous care under fluoroscopic guidance. A needle is inserted through the cheek to access the base of the skull, where the nerve exits. An electrode is then precisely positioned at the Gasserian ganglion, a critical nerve structure that relays pain sensations.

Patients are kept awake, under mild sedation, to provide real-time feedback to guide the location of the electrode. This ensures the electrode is accurately placed to target the pathway of the pain signals. Once the correct position is confirmed, a radiofrequency current is applied to create a lesion on the nerve, effectively disrupting the transmission of pain signals.

The procedure offers immediate pain relief by numbing the nerve, with the effects typically lasting several years.

However, radiofrequency thermocoagulation is not without its risks. Potential complications include excessive facial numbness, weakness in the masticatory muscles, and corneal hypoesthesia. These complications are generally temporary and not permanent.

In conclusion, radiofrequency thermocoagulation offers a promising option for those struggling with trigeminal neuralgia. It strikes a balance between efficacy and safety, providing a viable option for patients who have exhausted other treatment avenues.

Reference:

Altamirano JM, Jimenez-Olvera M, Moreno-Jimenez S, Gutierrez-Aceves GA, Velasco-Campos F, Navarro-Olvera JL, et al. Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study. Pain Pract. 2024;24:514-24. doi: 10.1111/papr.13327.