Trigeminal Neuralgia: Treatment by Percutaneous Electrocoagulation
(Radio frequency Thermal Lesion - RFTC)

Over most of this century, a variety of neurosurgical operations and procedures have been introduced to treat trigeminal neuralgia. The objective of almost all these treatment have been the creation of a sensory deficit in are of pain a especially in the trigger area of trigeminal never distribution (V₁, V₂, V₃). Major intracranial operative procedure with their attendant risks, gave way in many places to percutaneous approaches to the ganglion and retrogasserian rootless (V1-2-3) for the instillation of alcohol, oiling water, phenol, Billon. In the early 1930s,Kirschner introduced his technique of elecrocoagulation of the gasserian ganglion using of diathermy apparatus. In 1970 Sweet introduced the radio frequency (RF) technique. This method is relatively very safe can be easily performed with almost minimal side effect of facial numbness or paresthesia. Very rarely patient may have dysesthesia and loss oat corneal retlex. The outcome in major centers shows excellent outcome in 60 to 70% cases, good in 20 to 25% cases, fair 5% cases & poor in rest of the cases. The effect of the pain relief was evaluated up to 10 years in above cases.

In Gujarat at, Baroda Neuro Surgical Hospital we have started treating the Trigeminal Neuralgia (severe pain at face) with radio frequency lesions (RF) since last 10 years. This is the FIRST private center in Gujarat to treat Trigeminal Neuralgia with RF Generator. The advantage of this treatment is to have long lasting pain relief with more precise lesion at gasser lion with the help of never stimulator and RF lesion Generator (RFLG).

Technique

Under radiological guidance the needle for RF stimulator is inserted at the level of foramen ovel. CSF is obtained. Mild sedation and local anesthesia is used. With never stimulator the nerve roots are located. The desired nerve roots (V1, V2, V3) stimulations will give tingling sensation in the distribution of pain area. Usually 50 to 60-Hz stimulations is adequate for stimulations of nerve roots. After confirmation of the exact site, the lesion is made with 60 to 90 degree temperature given for 60 to 90 seconds. For the lesion patient is anaesthetized with short acting anesthetic agents.

Trigeminal Nerve at foramen oval with V₁, V₂, V₃ nerve roots.

Patient is kept for 6 to 8 hours in the hospital, after the procedure to observe any side effects and discharge later.

Complications

In last 10 years, I have treated more than 250 cases of Trigminal Nerualgia with RF Generator. Only 25 cases have inadequate pain relief, which on repeat producer all of them got near total relief Two case had corneal irritation after the procedure due to sensory loss of cornea. With eye production and teardrops treatment patients were better. No other side effects like carotid cavernous fistula, meningitis, and Vasovagle shock were observed, as mentioned in major series.

Conclusion: Compared to the major craniotomy (posterior fossa surgery), risk & complications are minimum with this with procedure &it is relatively safe & simple procedure for pts.