The Role of Radiofrequency Ablation in the Treatment of Trigeminal Neuralgia: A Narrative Review

Abstract

Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, the largest of the cranial nerves. It is characterized by severe, sudden, and recurrent facial pain, often triggered by light touch or a breeze. Treatment options for TN include medication, nerve blocks, and surgery, but radiofrequency ablation (RFA) has emerged as a promising alternative. RFA is a minimally invasive procedure that uses heat energy to destroy the small portion of the trigeminal nerve responsible for the pain. The procedure is performed under local anesthesia and can be done as an outpatient procedure. RFA has been shown to provide long-term pain relief for TN patients with a low complication rate. However, RFA is not suitable for all TN patients and may not be effective for those with multiple pain sites. Despite these limitations, RFA is a valuable option for TN patients who are not responding to other treatments. Furthermore, RFA is a good alternative for a patient unsuitable for surgery. Further research is needed to fully understand the long-term effectiveness of RFA and identify the best candidates for the procedure.

Trigeminal neuralgia and COVID-19 vaccination or infection

“…Trigeminal neuralgia (TN) is an infrequent condition manifested by excruciating unilateral electric shock-like facial pain, with classical abrupt onset and termination [1][2][3][4][5][6][7][8] . TN may be idiopathic, but the etiological factors include vascular nerve compression (classic TN), multiple sclerosis, tumor, trauma, herpes zoster, and temporomandibular dysfunction (secondary TN); arterial hypertension and diabetes are comorbidities 1,2,5,8 .…”

“…The estimated prevalence is up to 13% yearly, 1 occurring more often among females between from 50 to 70 years of age, and mainly affecting the second or third branches 1,2 . The intensity and persistence of painful episodes cause deleterious effects on the work activities and quality of life of the patients, mainly those presenting refractory pain [1][2][3][4][5] . Consistent literature data have confirmed the high efficacy and tolerability of utilizing gabapentin and other α2δ ligands to control patients with this excruciating pain, carbamazepine and oxcarbazepine are also recommended to first-line pharmacotherapy; additional procedures can include nerve blocks, surgery, or radiofrequency ablation [1][2][3][4][5][6][7][8] .…”

Non-Surgical Treatments of Trigeminal Neuralgia from the Perspective of a Pain Physician: A Narrative Review

“…Ablative therapies are defined as procedures for the destruction of the involved neural structure and can be performed at different anatomical segments of the nerve [ 40 ]. RF ablation applies radio waves directly to the affected nerve to interrupt the pathological transmission of nociceptive signals [ 41 ]. Various complications following RF ablation of the Gasserian ganglion have led to increased attention to the peripheral block and RF ablation of the trigeminal nerve.…”

“…For safe and successful RF ablation of the Gasserian ganglion, the triangular plexus, which comprises the posterior margin of the Gasserian ganglion to the path over the upper petrous ridge, is the best location for generating more selective lesions [ 46 ]. In 13 studies with 1146 patients, RF ablation in TN had a success rate of 89.2% and a recurrence rate of 7.9% [ 41 ]. CRF generates a 5 to 15 mm electric field that increases the temperature of the affected tissue to over 45 °C, which produces local tissue damage and loss of myelinated nerve fibers.…”

Analyzing the Effect of Intraoperative Stimulation Voltage on Facial Numbness Following Radiofrequency Thermocoagulation in the Treatment of Idiopathic Trigeminal Neuralgia

“…During RFT surgery, the sensory stimulation voltage (SV) is commonly used to pinpoint the needle tip [ 26 ]. The SV serves as a potential indicator of the distance between the active tip and the target division of the trigeminal ganglion [ 27 ]. Maintaining an appropriate distance ensures that heat selectively ablates nociceptive fibers, preventing unintended damage to tactile fibers and minimizing the risk of facial numbness.…”