Pulsed Radiofrequency: A Management Option for Recurrent Trigeminal Neuralgia Following Radiofrequency Thermocoagulation

Abstract

Pain relief comparable with radiofrequency thermocoagulation (RFT) alone and fewer side effects than RFT have been achieved by combination treatment with pulsed radiofrequency (PRF) and short-duration RFT in trigeminal neuralgia (TN). We report the successful management of recurrent TN after RFT with single PRF in 2 patients. The RFT treatment was performed in 2-3 cycles for each division, with the lesion setting at 75°C-80°C for 90 seconds. The PRF treatment was applied for 120 seconds, with a generator output of 45 V, not exceeding a temperature of 42°C at the tip of the electrode. In case 1, pain relief was immediately achieved by RFT (75°C for 90 seconds), with moderate hypesthesia. Relapse of the triggered pain occurred 6 months later, and PRF was then applied. Long-term (18 months) pain relief without any additional pharmacologic or other treatment was reported. In case 2, a second RFT treatment at a higher temperature (80°C) was performed after recurrence after the first RFT within a week. Accompanied by worse hypesthesia, complete pain relief lasted for 6 months until the recurrence of pain was triggered by toothbrushing. PRF was then applied, and complete analgesia with long-term follow-up (28 months) was achieved. The PRF treatment for recurrent TN after RFT in this study could be viewed as a combination of PRF and RFT treatments in succession. Therefore, PRF and RFT should be considered to be complementary rather than alternative in the management of TN.