Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia

Abstract

Objective: Radiofrequency thermocoagulation (RFT) for refractory trigeminal neuralgia is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience. Here, we present RFT under neuromonitoring guidance and general anesthesia.

Method: Stimulation of trigeminal branches at the foramen ovale with the tip of the RFT cannula is performed under short general anesthesia. Antidromic sensory-evoked potentials (aSEP) are recorded from the 3 trigeminal branches. The cannula is repositioned until the desired branch can be stimulated and lesioned.

Conclusion: aSEP enable accurate localization of involved trigeminal branches during RFT and allow performing the procedure under general anesthesia.

Keywords: Antidromic sensory–evoked potentials; Neuromonitoring; Radiofrequency thermocoagulation; Trigeminal neuralgia.