[Treatment of trigeminal neuralgia with thermorhizotomy]

Percutaneous radiofrequency (RF) thermorhizotomy of the trigeminal nerve is an effective treatment for trigeminal neuralgia. Long-term efficacy is proportional to the degree of postoperative hypoesthesia. The advantage is the topographic selectivity of the thermolesion, provided the electrode tip is placed accurately. This requires precise x-ray guidance and neurophysiological testing. In addition to the indication in idiopathic trigeminal neuralgia, especially for elderly patients with precarious conditions, thermorhizotomy is particularly useful for treating patients with trigeminal neuralgia due to multiple sclerosis. It can also be applied to symptomatic neuralgias, but only when the main components are of the paroxysmal and/or the allodynic types ; the thermorhizotomy method could aggravate permanent components, especially when burning pain predominates; it could also increase preexisting trophic disturbances, particularly keratitis.