Radiofrequency thermoneurolysis of peripheral nerves for control of trigeminal neuralgia

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Abstract
Radiofrequency thermoneurolysis (RFTN) was performed in the peripheral infraorbital and inferior alveolar nerves of 8 patients with paroxysmal trigeminal neuralgias. Pain severity as measured by tourniquet test and global estimate was significantly reduced in 7 of 8 patients. The sharp, paroxysmal component of neuralgia was controlled in all 7 successes although significant pain was recurring in 2 patients 1 yr post-operatively. Neurosensory threshold responses to tactile-discriminative stimuli were not permanently changed from pre-lesion levels but pain detection and pain tolerance threshold responses to mechanical pin-pressure and thermal stimuli were significantly raised, suggesting that RFTN is more selective for small myelinated and unmyelinated fibers. This procedure was safe, effective, simple and predictable on the basis of diagnostic blocks. It is probably a temporary control pressure which can be repeated. It may prove useful as a test to identify those patients who may experience anesthesia dolorosa. It is suggested for patients with toxic responses to medical therapy and as an alternative to more invasive surgeries for the long-term management of trigeminal neuralgia.