Radiofrequency thermoneurolysis of peripheral nerves for control of trigeminal neuralgia

Radiofrequency thermoneurolysis (RFTN) was performed in the peripheral infraorbital and inferior alveolar nerves of eight patients with paroxysmal trigeminal neuralgias. Pain severity as measured by tourniquet test and global estimate was significantly reduced in seven of eight patients. The sharp, paroxysmal component of neuralgia was controlled in all seven successes although significant pain was recurring in two patients one year 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 found to be safe, effective, simple, and predictable on the basis of diagnostic blocks. Results suggest that it is a temporary control measure which nevertheless can be repeated. It may also 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.