Radiofrequency Thermocoagulation for Trigeminal Neuralgia

  • Parmod Kumar Bithal


Trigeminal neuralgia (TGN) can be managed medically, surgically, or by percutaneous techniques. Among the percutaneous techniques, radiofrequency thermocoagulation (RFT) offers many benefits over others. The radiofrequency (RF) current is a low energy, high frequency (50–500 kHz), alternate current. When RF current is delivered to the biological tissues, it causes oscillation of the molecules within the tissue. That leads to production of heat by friction between the oscillating particles [1]. A lesion is formed if the temperature within the neuronal tissue exceeds 40 °C [2]. Two different modalities of RF currents are commonly practiced in interventional pain medicine: (1) Continuous radiofrequency (CRF) and (2) Pulsed radiofrequency (PRF). In CRF, an alternate current in the frequency range of 100–500 kHz is applied continuously to a target nerve; the aim is to produce a thermal lesion thereby causing interruption of afferent pathways for nociception [1]. The thermal (Heat) energy is produced transversely along the active tip of the electrode. Hence, an alignment of the active tip is usually desired alongside of the nerve targeted, and not perpendicular to it [3]. In PRF, an alternate current is applied to the target nerve without generating significant heat. Typically, high frequency current of 50 kHz is delivered over 20 ms pulses at a frequency of 2 Hz, for a duration of 120 s. The long pause between pulses results in heat dissipation, thereby keeping tissue temperature below neuro-destructive threshold of 45 °C. Pulsing the current also allows the generator power output to be substantially increased. The usual voltage output in CRF is 15–25 V, while PRF is usually carried out at 45 V. Heating is further minimized by restricting electrode tip temperature below 42 °C. Thus, the low temperature in the tissues is insufficient to produce neural lesion. In contrast to CRF, the distal active tip is desired to be perpendicular to the target nerve in PRF, as it allows delivery of highest intensity with such a placement [1].


  1. 1.
    Rea W, Kapur S, Mutagi H. Radiofrequency therapies in chronic pain. Contin Educ Anaesth Crit Care Pain. 2011;11:35–8.CrossRefGoogle Scholar
  2. 2.
    Slappendel R, Crul B, Braak GJ, Geurts JW, Booji LH, Voerman VF, de Boo T. The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blind randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain. 1997;73:159–63.CrossRefGoogle Scholar
  3. 3.
    Lord SM, Bagduk N. Radiofrequency procedures in chronic pain. Best Pract Res Clin Anesthesiol. 2002;16:597–617.CrossRefGoogle Scholar
  4. 4.
    Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. J Neurosurg. 1974;40:143–56.CrossRefGoogle Scholar
  5. 5.
    Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic. Trigeminal neuralgia: 25 years’ experience with 1600 patients. Neurosurgery. 2001;48:532–4.Google Scholar
  6. 6.
    Emril DR, Ho K. Treatment of trigeminal neuralgia: role of radiofrequency ablation. J Pain Res. 2010;3:249–54.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Wang JY, Dender MT, Bettegowda C. Percutaneous procedures for the treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2016;27:277–95.CrossRefGoogle Scholar
  8. 8.
    Raj PP, Lou L Erdine S, Staats PS, Waldman SD, editors. Radiographic imaging for regional anesthesia and pain management. Philadelphia PA: Churchill Livingstone; 2003.Google Scholar
  9. 9.
    Koizuka S, Saito S, Kubo K, Tomioka A, Takazawa T, Sakurazawa S, Goto F. Percutaneous radiofrequency mandibular nerve rhizotomy guided by CT fluoroscopy. AJNR. 2006;27:1647–8.PubMedGoogle Scholar
  10. 10.
    Tang YZ, Wu BS, Yang LQ, Yue JN, He LL, Li N, et al. The long term effective rate of different branches of idiopathic trigeminal neuralgia after single radiofrequency thermocoagulation. Medicine (Baltimore). 2015;94:e1994.CrossRefGoogle Scholar
  11. 11.
    Nie F, Su D, Shi Y, Chen J, Wang H, Chen Y, et al. A prospective study of x-ray imaging combined with skin stimulation potential- guided percutaneous continuous radiofrequency thermocoagulation of the Gasserian ganglion for the treatment of trigeminal neuralgia. Pain Med. 2014;15:1464–9.CrossRefGoogle Scholar
  12. 12.
    Hart MG, Nowell M, Coakham HB. Radiofrequency thermocoagulation for trigeminal neuralgia without intraoperative patient waking. Br J Neurosurg. 2012;392:110–5.Google Scholar
  13. 13.
    Patil AA, Chamczuk AJ, Nelson B. Stereotactic radiofrequency ablation of trigeminal ganglion with intraoperative CT scan and under general anesthesia. Open J Modern Neurosurg. 2016;6:55–9.CrossRefGoogle Scholar
  14. 14.
    Kosugi S, Shiotani M, Otsuka Y, Suzuki T, Kotari N, Hashguchi S, Morisaki H. Long term outcomes of percutaneous radiofrequency thermocoagulation of Gasserian ganglion for 2nd and multiple-division trigeminal neuralgia. Pain Pract. 2015;15:223–8.CrossRefGoogle Scholar
  15. 15.
    Fraioli B, Epsosito V, Guidetti B, Cruccu G, Manfredi M. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization and percutaneous compression of the Gasserian ganglion and/or retrogasserian rootlets: long term results and therapeutic protocols. Neurosurgery. 1989;24:239–45.CrossRefGoogle Scholar
  16. 16.
    Finch PM. A curved approach to nerve blocks and radiofrequency lesioning. Pain Digest. 1997;7:251–7.Google Scholar
  17. 17.
    Tobler WD, Tew JM Jr, Cosman E, Keller JT, Quallen B. Improved outcome in the treatment of trigeminal neuralgia by percutaneous stereotactic rhizotomy with a new, curved tip electrode. Neurosurgery. 1983;12:313–7.CrossRefGoogle Scholar
  18. 18.
    Laghmari M, El Ouahahi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia. Surg Neurol. 2007;68:505–12.CrossRefGoogle Scholar
  19. 19.
    Jin HS, Shin JY, Kim YC, Lee SC, Choi EJ, Lee PB, Moon JY. Predictive factors associated with success and failure for radiofrequency thermocoagulation in patients with trigeminal neuralgia. Pain Physician. 2015;18:537–45.PubMedGoogle Scholar
  20. 20.
    Yizhong H, Jiaxiang NI, Baishan WU, Mingwei HE, Liqiang Y, Wang Q. Percutaneous radiofrequency thermocoagulation for the treatment of different types of trigeminal neuralgias: evaluation of quality of life and outcomes. J Huazhong Univ Sci Technolog Med Sci. 2010;30:403–7.CrossRefGoogle Scholar
  21. 21.
    Sindou M, Tatli M. Treatment of trigeminal neuralgia with thermocoagulation. Neurochirurgia. 2009;55:203–10.CrossRefGoogle Scholar
  22. 22.
    Bender MT, Pradilla G, Batra S, See AP, James C, Prado CA, et al. Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis. J Neurosurg. 2013;118:329–36.CrossRefGoogle Scholar
  23. 23.
    Bogduk N. Pulsed radiofrequency. Pain Med. 2006;7:396–407.CrossRefGoogle Scholar
  24. 24.
    Li X, Ni J, Yang L, Wu B, He M, Zhang X, Ma L, Sun H. A prospective study of Gasserian ganglion pulsed radiofrequency with continuous radiofrequency for the treatment of trigeminal neuralgia. J Clin Neurosci. 2012;19:824–8.CrossRefGoogle Scholar
  25. 25.
    Zhao WX, Wang Q, He MW, Yang B, Wu S, Ni JX. Radiofrequency thermocoagulation combined with pulsed radiofrequency helps relieve postoperative complications of trigeminal neuralgia. Genet Mol Res. 2015;14:7616–23.CrossRefGoogle Scholar
  26. 26.
    Luo F, Meng L, Wang T, Yu X, Shen Y, Ji N. Pulsed radiofrequency treatment for idiopathic trigeminal neuralgia: a retrospective analysis of the causes for ineffective pain relief. Eur J Pain. 2013;17:1189–92.CrossRefGoogle Scholar
  27. 27.
    Liao C, Visocchi M, Liu P, Zhang W. Pulsed radiofrequency: a management option for recurrent trigeminal neuralgia following radiofrequency thermocoagulation. World Neurosurg. 2017;97:760.e5–7.CrossRefGoogle Scholar
  28. 28.
    Meng Q, Zhang W, Yang Y, Zhou M, Li X. Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia. J Neurosurg Anesthesiol. 2008;20:131–5.CrossRefGoogle Scholar
  29. 29.
    Rath G, Dash HH, Bithal PK, Goyal V. Intracranial hemorrhage after percutaneous trigeminal rhizotomy. Pain Pract. 2009;9:82–4.CrossRefGoogle Scholar
  30. 30.
    Ward L, Khan M, Greig M, Dolin SJ. Meningitis after percutaneous radiofrequency trigeminal ganglion lesion. Case report and review of literature. Pain Med. 2007;8:535–8.CrossRefGoogle Scholar
  31. 31.
    Yang Y, Shao Y, Wang H, Liu Y, Zhu S, Wu C. Neuronavigation assisted percutaneous thermocoagulation in trigeminal neuralgia. Clin J Pain. 2007;23:159–64.CrossRefGoogle Scholar
  32. 32.
    Guo Z, Wu B, Du C, Cheng H, Tian Y. Stereotactic approach combined with 3D CT reconstruction for difficult to access foramen ovale on radiofrequency thermocoagulation of the Gasserian ganglion for trigeminal neuralgia. Pain Med. 2016;17:1704–16.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Parmod Kumar Bithal
    • 1
  1. 1.Division of Neuroanesthesiology, Department of Anesthesiology and OR AdministrationKing Fahad Medical CityRiyadhKingdom of Saudi Arabia

Personalised recommendations