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Papers of the Week

2020 Aug 13

Pain Pract

Bipolar Pulsed Radiofrequency for Trigeminal Neuralgia. A Report of two cases.


Silva V, Day M, Santiago M
Pain Pract. 2020 Aug 13.
PMID: 32790964.


Trigeminal neuralgia (TN) is the most common cause of facial pain, leading to significant disability and impacting a patient´s quality of life. Percutaneous procedures like continuous radiofrequency (CRF), pulsed radiofrequency (PRF) and combined continuous and pulsed (CCPRF) have been studied in past years comparing different voltages in order to find more effective therapies with fewer complications, i.e. numbness and masseter muscle weakness. With regards to young patients, there is still insufficient evidence on the most appropriate procedure in this patient population. PRF does not cause thermal damage. The mechanism of action involves delivering an electrical field to targeted nerves or tissues, modulating pain. We propose that bipolar pulsed radiofrequency (2 parallel cannulas) in the trigeminal ganglion produce a denser and larger field resulting in more effective controlled pain. We present two cases of 40- and 48 year-old males with severe V2-3 TN who underwent bipolar PRF. We performed bipolar PRF on trigeminal ganglion through foramen ovale using two 22 G 100 mm cannula with 10 mm active tip. Parameters used were voltage 85 V, pulse width 20 ms and total duration time of 6 minutes. Both patients reported complete relief of pain after procedure and at 2 year up were pain free and experienced a better quality of life. There were no complications reported. CONCLUSIONS: Bipolar pulsed radiofrequency could be a non-neurodestructive option for young people with TN and deserves further investigation as a treatment option.