Background: Trigeminal neuralgia (TN) is a pain appearing in the ophthalmic (V1), maxillary (V2),
and mandibular (V3) trigeminal branches. Pharmacologic treatment is the first line for TN; however,
many patients prefer to receive minimally invasive treatment rather than medicine because of
intolerable side effects. Thermocoagulation radiofrequency (TRF) is a minimally invasive treatment
that has been shown to effectively treat the maxillary (V2) and mandibular (V3) divisions, but the
safety of TRF treatment of the ophthalmic (V1) division has been controversial.
Objective: This study was to observe the effectiveness and safety of TRF treatment of the
ophthalmic (V1) division of trigeminal branches in idiopathic TN patients.
Study Design: An observational study.
Setting: All of patients received temperature controlled TRF, the effectiveness and safety of TRF
was assessed by VAS and complications.
Methods: Eighty patients with ophthalmic division (V1) or ophthalmic division (V1) combined
with maxillary (V2) or mandibular (V3) divisions of idiopathic TN were treated with step-increased
temperature TRF for 6 minutes. At a pulse width of 20 ms, the temperature was titrated up 2
degrees from 60 degrees to 66 degrees every 60 seconds, and then another 66 degrees or 68
degrees for 2 minutes. Meanwhile, the tip of the cannula was turned 180 degrees with each
temperature titration. Patients were assessed for pain relief and corneal reflex, numbness, and
masticatory muscle weakness at one week, one month, and 3 months after the procedure.
Results: Eighty patients were successfully treated with temperature controlled TRF for ophthalmic
(V1) division. Excellent pain relief was achieved in 79 of 80 patients (98.75%) after one week, one
month, and 3 months, and 78 of 80 patients (97.5%) patients experienced tolerable numbness.
Only one patient lost the corneal reflex, 14 experienced a corneal reflex that was mildly decreased,
and 2 patients felt a foreign body sensation in the ipsilateral eye after TRF, but there were no
corneal ulcers, incidences of blindness, or other complications.
Limitations: This study is limited by being an observation study and a non-prospective trial with
a short-term follow-up period.
Conclusion: Temperature controlled TRF to the ophthalmic division (V1) of the semilular ganglion
is effectiveness and safe in TN.
Key words: Thermocoagulation radiofrequency, pulsed radiofrequency, trigeminal neuralgia,
ophthalmic division, trigeminal ganglion, pain, numbness, corneal reflex
Peripheral Neurectomy: A Minimally Invasive Treatment for Trigeminal Neuralgia. A Retrospective Study
