a1. Radiofrequency Thermocoagulation

 

• The procedure is carried out in the operating room. After being laid on your back, the cheek area where the procedure will take place is numbed with local anesthesia.

• The patient is sedated during the radiofrequency procedure. However, at the beginning of the procedure, it's necessary for the patient to be somewhat awake and responsive to determine which branch of the trigeminal nerve is affected. This period lasts only a few minutes.

• During this time, blood pressure, heart rate, and respiration are continuously monitored by an anesthesiologist.

 

• Under radiological imaging guidance, a special needle-electrode is advanced to the region where the nerve is located. Once the position of the needle is confirmed radiologically, radiofrequency stimuli are delivered through the device to ascertain if the patient feels stimulation in the area of pain.

• Once the correct placement of the needle is confirmed, radiofrequency energy is used to ablate the pain-carrying fibers of the nerve in a controlled manner. The ablation process lasts about one minute. If more than one branch of the trigeminal nerve is affected, the nerve may be ablated two or three times, with each ablation lasting one minute. Superficial anesthesia is applied to the patient at this stage to prevent any pain sensation.

• The entire procedure takes about 30 minutes.

•  Following the radiofrequency procedure, numbness occurs in the area of the affected nerve, similar to the numbness experienced during local anesthesia for tooth extraction. However, this numbness is permanent. Patients are informed about this in detail beforehand. In patients who are uncertain about this aspect, the procedure is initially carried out only with local anesthesia to demonstrate the aftermath. This numbness is actually an indicator of the success of the method. Pain does not occur in patients for a period of 3-8 years.

• Trigeminal neuralgia is one of the most unbearable pains. Patients may not be able to eat, drink, or shave for months. Radiofrequency is only applied in such patients. Therefore, patients are willing to accept such numbness.

• Radiofrequency is generally applied once, although in some patients it may be applied twice. Thereafter, the patient lives pain-free for many years. When the pain recurs, medication is initially attempted to control the patient’s pain, and if ineffective, radiofrequency can be reapplied.

• Patients can return to work one day after the radiofrequency application.

The radiofrequency thermocoagulation under imaging

What are the risks and side effects?

The most significant side effect during radiofrequency application is the emergence of a different type of pain that bothers patients despite the numbness in the area. This pain is called anesthesia dolorosa, which means pain in the anesthetized area. Unlike in trigeminal neuralgia, there's no electric, lightning strike characteristic. This pain is continuous, burning, and permanent, and occurs in a few out of a thousand patients. Various medications are tried against this pain. Every patient is warned about this side effect before the radiofrequency application.

The risk of radiofrequency is not as high as open surgery. Therefore, it's a preferred method, especially for patients over the age of 50.

Who is not suitable for radiofrequency thermocoagulation?

Radiofrequency thermocoagulation cannot be performed on patients with bleeding disorders or those who have developed infections on the face or any part of the body.