Radiofrequency thermal coagulation therapy uses high temperature to act on the ganglia, nerve trunk and nerve roots to coagulate and denature their proteins, thus blocking the transmission of nerve impulses. Currently, radiofrequency thermal coagulation therapy is widely used in clinical practice. Radiofrequency thermocoagulation is an important treatment for trigeminal neuralgia, which includes trigeminal nerve root pulse stimulation and temperature-controlled coagulation techniques. Intermittent pulsed current stimulation is applied prior to disruption to understand whether the stimulation area matches the patient’s pain onset area, making the disruption more delicate and safe.
Since the unmyelinated fine fibers that conduct nociceptive sensations degenerate at 70°-75°C, whereas the myelinated thick fibers that conduct tactile sensations can tolerate higher temperatures, temperature-controlled thermal coagulation is used to control the destruction temperature at 75°C. In this way, the differences in temperature tolerance of different nerve fibers can be exploited to selectively destroy the fine fibers that conduct facial nociceptive sensations in the semilunar ganglion, while preserving the thick fibers that conduct tactile sensations with greater resistance to heat. The pain relief is immediate and the facial pain is preserved. Immediate pain relief is achieved while preserving the sensation of the face.
The method is safe and efficient, and the procedure takes 30-60 minutes. Patients receive temperature-controlled treatment while awake, and the effect is obvious, relieving the worries of long-term pain and taking painkillers. Due to the easy operation of radiofrequency therapy, good treatment effect, repeatable implementation, and relatively low recurrence rate, low cost, happy to be accepted by the majority of patients.
Indications
1.Primary trigeminal neuralgia, the effect of taking medication is not satisfactory;
2, there are obvious adverse drug reactions to painkillers such as carbamazepine;
3.Patients with trigeminal neuralgia who are too old and frail to tolerate craniotomy treatment;
4, unwilling to accept cranial trigeminal neurovascular decompression surgery;
5.Patients with recurrence after cranial trigeminal neurovascular decompression;
6.Patients with recurrence after controlled radiofrequency thermocoagulation treatment can undergo coagulation treatment again;
7, Gamma knife treatment effect is not satisfactory, the pain is not eliminated or reduced;
8, trigeminal neuralgia due to tumor, the pain does not improve with gamma knife or surgical treatment.
Adverse reactions and complications
1, pain during operation This method requires the cooperation of the patient. Before treatment, it should be made clear that such treatment under local anesthesia is painful, and the patient’s understanding and cooperation must be obtained, and attention should be paid to slow heating from 60℃, which can reduce the pain caused by sudden high temperature.
2.Intracranial hemorrhage The medial aspect of the semilunar ganglion is adjacent to the cavernous sinus and the internal carotid artery. (Instrument positioning puncture can be completely avoided)
3, cerebral nerve damage such as facial light paralysis, etc.
4, intracranial infection Strict aseptic operation can prevent secondary intracranial infection. Special attention should be paid to prevent repeated punctures of the buccal mucosa by the puncture needle to bring bacteria from the oral cavity into the skull.
Herpes zoster can appear in the affected area several days after surgery, and its mechanism is not clear. Local nail violet or cortisone ointment can be applied, and it will heal in a few days.
6, keratitis a more serious complication of hemianoplasty is the loss of corneal reflexes, serious cases can cause paralytic keratitis, which can eventually lead to blindness. It is important to control the heating temperature and time during the procedure and to check the change of corneal reflex at any time. In cases where loss of corneal reflex has occurred, patients should be instructed to wear glasses and use eye ointment to protect the cornea and prevent keratitis. In some cases, it takes several months for the corneal reflex to gradually recover after it disappears.
7, facial sensory disorders Most patients can have different degrees of facial sensory disorders after treatment. In the 315 cases summarized by Menzel, about 93.1% of patients had different degrees of numbness or burning sensation in the face after treatment.
Therefore, before treatment, patients and their families have the right to ask the treating physician about the possible side effects of treatment.