What is Radio frequency Lesioning (RFLG) for treatment of Trigeminal neuralgia?
Radio frequency lesioning of the trigeminal ganglion was introduced into clinical practice in the latter half of the twentieth century. Though not a surgical procedure per se, it requires to be done in the operation theatre or in operating room-like conditions, where anaesthesia may be safely administered.
It is one of the popular surgical alternatives to treatment of Trigeminal neuralgia. Microvascular Decompression surgery is the only surgical procedure available so far.
What does RFLG mean?
Radio frequency is a kind of localized heat that is applied to the trigeminal ganglion. It is called lesioning because a lesion or damage is done to the nerve/ ganglion. It is also called gangliolysis.
How is Radio frequency lesioning (RFLG) for Trigeminal neuralgia performed?
The patient is given a short-acting anaesthetic or sedative and the nerve is located under X-ray (fluoroscopic) guidance using a long needle. He/she is then woken up and tingling/ pain in the area of the neuralgic pain is induced for confirmation. They are then put back to sleep and heat applied to the nerve/ ganglion.
This damages the nerve and decreases the pain signals transmitted to the brainstem. As one may recall, the cause of trigeminal neuralgia is abnormal signalling along the Trigeminal nerve.
This procedure usually takes about an hour.
How does RFLG affect pain of Trigeminal Neuralgia?
If done adequately, the nerve injury caused by the Radio frequency heat prevents pain signals from being transmitted from the face to the brain. This nerve injury may or may not also cause facial numbness to varying degrees. It is most effective in classical TN. And is usually done for TN in V2 and V3 divisions.
How useful is Radio frequency lesioning for treatment of Trigeminal neuralgia?
Patient selection is very important for successful pain relief. If there are multiple trigger zones, or if TN affects all trigeminal divisions, RFLG is not generally recommended. It is most useful in classical TN affecting V2 or V3 divisions, and in TN caused by Multiple Sclerosis.
How long does the effect of RFLG last?
Though RFLG has initial success rates of about 80-90%, and the pain goes away almost immediately, it is not long-lasting. Only about 75% remain pain-free after a few months to a few years.
What are the consequences or side-effects of RFLG?
Though it is generally safe, RFLG is not without potential complications.
- Facial numbness and corneal numbness are the commonest unwanted effects of this procedure.
- Rarely a condition called anaesthesia dolorosa may develop (numbness with constant severe pain).
- Facial blisters may appear a few days after lesioning, though they are transient.
- Infection leading to meningitis may occur.
- Deaths due to internal bleeding into the brain.
Can an injection of a drug be made instead of RFLG?
Certainly. Glycerol injections have stood the test of time, but have slightly lower success rates than RFLG.
What is the best treatment for Trigeminal Neuralgia?
Microvascular Decompression surgery is the best treatment. Primarily because it aims at removing the cause of the pain, which is the compressing blood vessel. All other procedures are nerve-destroying procedures. Dr Jaydev Panchwagh has performed more than 1000 MVD surgeries over the last twenty years and has excellent pain-relief rates, to the tune of 98%.