Management of Refractory Trigeminal Neuralgia Using Extended Duration Pulsed Radiofrequency Application

Trigeminal neuralgia (TN) produces incapacitating facial pain that reduces quality of life inpatients. Thermal radiofrequency (RF) ablation of gasserian ganglion (GG) is associated withmasseter weakness and unpleasant sensations along the distribution of the ablated nerve. Pulsedradiofrequency (PRF) of GG has minimal side effects but literature is inconclusive regarding itsbenefit in refractory TN. Increasing the duration of PRF application to 6 minutes in TN producedencouraging results. PRF application to the saphenous nerve for 8 minutes reported improvedpain relief and patient satisfaction. We report successful management of two patients of classicTN, which were refractory to medical management and interventional nerve blocks. The lesionsite were confirmed with motor and sensory stimulation through a 22 G, 10 cm RF needle with5 mm active tip. Both the patients received four cycles of PRF at 42 °C with each cycle of 120seconds (8 minutres). The visual analogue scale (VAS) in case 1 reduced from pre block scoreof 80 to score 10 postblock, while in case 2 the VAS reduced from pre-block score of 85 toscore 15 postblock. During follow up both the patients are now pain free with minimal dose ofcarbamazepine at 12 and 6 months respectively. We used PRF for longer duration (8 minutes)in these patients, which resulted in improved VAS and WHOQOL-BREF score in these patients.PRF of mandibular division of GG for extended duration provided long-term effective pain reliefand quality of life in patients of refractory classic TN.Key words: Trigeminal neuralgia pain, pulsed radiofrequency ablation, interventionalapproach