Trigeminal neuralgia (TN) is a neuropathic pain condition affecting the face. It has a significant impact on the quality of life and physical function of patients. Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge. Secondary causes such as multiple sclerosis or brain tumors can also produce symptomatic TN. Treatment must be individualized to each patient. Carbamazepine remains the drug of choice in the first-line treatment of TN. Minimally invasive interventional pain therapies and surgery are possible options when drug therapy fails. Younger patients may benefit from microvascular decompression. Elderly patients with poor surgical risk may be more suitable for percutaneous trigeminal nerve rhizolysis. The technique of radiofrequency rhizolysis of the trigeminal nerve is described in detail in this review.

Keywords: interventional treatment, minimally invasive, pain management, radiofrequency rhizolysis, trigeminal neuralgia

What is radiofrequency ablation for trigeminal neuralgia?

Ablation is a medical term that refers to the removal of tissue. Radiofrequency ablation, or RFA, is a surgical technique that directs high-frequency heat onto targeted areas of the body, such as tissues, tumors and – in the case of chronic pain – nerves.

If you suffer from trigeminal neuralgia, your neurosurgeon uses radiofrequency ablation to target the trigeminal nerve, destroying its ability to transmit pain signals to your brain.

Am I a candidate for radiofrequency ablation surgery at UCLA?

The first line of treatment for trigeminal neuralgia is medication. If you suffer from severe facial pain and do not respond well to medication, your doctor may recommend radiofrequency ablation surgery.

What happens during radiofrequency ablation for trigeminal neuralgia?

Patients are awake and asleep at different times during radiofrequency ablation for trigeminal neuralgia. Here’s what you should expect:

While you are asleep under general anesthesia, your neurosurgeon will carefully place a needle through the corner of your mouth to reach the trigeminal nerve at the base of the skull.

After X-rays confirm the needle is in place, your neurosurgeon will wake you up, stimulate the nerve and ask if you feel the stimulation in the same place where you experience pain. This step confirms that your doctor has targeted the right location.

After you are put back to sleep, your neurosurgeon uses radiofrequency heat to slightly injure the nerve just enough that it causes some facial numbness and tingling and takes the pain away.