What is the role of pulsed radiofrequency of trigeminal ganglia in the management of burchiel classification TN2 trigeminal neuralgia

Facial pain has been classified by Eller and colleagues based on information from the patient’s medical history. This classification appears to be simple and reproducible. TN2 is described when idiopathic trigeminal facial pain is aching, throbbing, burning for more than 50% of the time. Pain in TN2 patients has been shown to be more difficult to treat, and anti-convulsants have only been found to be marginally effective. We present a retrospective review of the case notes of these twelve patients with TN2 pathology from a single tertiary referral hospital. We looked at demographics, medication use and treatment outcome. Of the 92 patients on the database, classification based on Burchiel et al., resulted in identification of 12 patients with TN2. The age range was from 41-78 years (median-61years). Of the 12 patients, 7(58%) were female and the rest were male. All these patients were initially tried on at least two anti-convulsants (one of which was Carbamazepine) before resorting to Pulsed radiofrequency either due to poor pain control or intolerable side effects of the medication. We have found consistent improvement with a standardized Pulsed radiofrequency regime. Our patients gained benefit for an average of 10 months (range 6-36months). Other outcome measures include the BPI-facial and Burchiel’s outcome grading (2). We also report that almost two-thirds of our patients are currently either off medication or their pain has improved but still on medication (at tolerable doses). Currently, 4 of the patients are medication free, 3 each are on Carbamazepine and Gabapentinoids. We conclude that management of TN2 should be multidisciplinary but Pulsed Radiofrequency appears to have a role. We propose a further study into optimal management of this particular subset of patients for whom standard treatments for trigeminal neuralgia are of uncertain benefit. (Burchiel K, J Neurosurg, 2010.)