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 before disruption to understand whether the stimulation area matches the patient’s pain onset area, making 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 that are more resistant 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 and low cost, it is gladly accepted by the majority of patients.
Indications for radiofrequency thermal coagulation therapy.
1.Primary trigeminal neuralgia, the effect of medication is not satisfactory;
2, to carbamazepine and other painkillers have obvious adverse drug reactions;
3.Patients with trigeminal neuralgia who are too old and frail to tolerate cranial surgery;
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, gamma knife or surgical treatment pain is not improved.
Adverse reactions and complications.
1, pain during operation. This method needs to obtain the cooperation of the patient. Before treatment, it should be made clear that such treatment under local anesthesia has a certain degree of pain, must obtain the patient’s understanding and cooperation, and pay attention to the slow heating from 60 ℃, can reduce the pain caused by the sudden high temperature.
2. Intracranial hemorrhage. The medial aspect of the semilunar ganglion is adjacent to the cavernous sinus and the internal carotid artery, so inadvertent puncture or entering the foramen ovale too deeply can easily damage and bleed, and intracranial hematoma can be formed in serious cases. (Instrument positioning puncture can be completely avoided.) 3, cerebral nerve damage, such as facial paralysis, etc.
4, intracranial infection. Strict aseptic operation can prevent secondary intracranial infections. 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.
5. Herpes zoster. It 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. One of the more serious complications of hemispheric ganglion thermocoagulation is the loss of corneal reflexes, which can cause paralytic keratitis in severe cases, and can eventually lead to blindness. It is important to control the heating temperature and time during the operation and to check the change of corneal reflex at any time. In cases where loss of corneal reflex has occurred, the patient 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 possible side effects of the treatment.