Pulsed Radiofrequency: A Management Option for Recurrent Trigeminal Neuralgia Following Radiofrequency Thermocoagulation.

Background: Pain relief comparable with radiofrequency thermocoagulation (RFT) alone and fewer side effects than RFT have been achieved by combination treatment with pulsed radiofrequency (PRF) and short-duration RFT in trigeminal neuralgia (TN).

Case Description: We report the successful management of recurrent TN after RFT with single PRF in 2 patients. The RFT treatment was performed in 2-3 cycles for each division, with the lesion setting at 75°C-80°C for 90 seconds. The PRF treatment was applied for 120 seconds, with a generator output of 45 V, not exceeding a temperature of 42°C at the tip of the electrode. In case 1, pain relief was immediately achieved by RFT (75°C for 90 seconds), with moderate hypesthesia. Relapse of the triggered pain occurred 6 months later, and PRF was then applied. Long-term (18 months) pain relief without any additional pharmacologic or other treatment was reported. In case 2, a second RFT treatment at a higher temperature (80°C) was performed after recurrence after the first RFT within a week. Accompanied by worse hypesthesia, complete pain relief lasted for 6 months until the recurrence of pain was triggered by toothbrushing. PRF was then applied, and complete analgesia with long-term follow-up (28 months) was achieved.

Conclusions: The PRF treatment for recurrent TN after RFT in this study could be viewed as a combination of PRF and RFT treatments in succession. Therefore, PRF and RFT should be considered to be complementary rather than alternative in the management of TN.