Treatment of trigeminal neuralgia by radiofrequency of the Gasserian ganglion

Trigeminal neuralgia (TN) is a neuropathic pain disorder that affects the trigeminal nerve distribution area. Pharmacological therapy has remained the first-line treatment for TN. If pharmacological intervention is not effective, surgical treatments including radiosurgery (mainly gamma knife therapy), radiofrequency (RF) of the Gasserian ganglion, and microvascular decompression have been utilized. RF is one of the most common procedures used to treat TN. Two RF approaches are commonly utilized: conventional radiofrequency (CRF) and pulsed radiofrequency (PRF). Both methods have been used to successfully treat TN; however, each procedure has distinct advantages and disadvantages. This article summarizes the current relevant literature to compare the treatment of TN with CRF vs. PRF. We discuss the treatment indications, operative methods, and complications of each treatment strategy. Most of the patients treated with CRF had a satisfactory outcome, whereas most PRF patients still had significant pain after the procedure. The application of a higher voltage can improve the curative effect of PRF, and its complications are less than CRF. Both CRF and PRF can be used to treat TN, and the former was more effective. Although the complications of CRF are more than those of PRF, most of them were short-lived and lacked sequelae. The pain relief rate in PRF-treated patients was significantly lower compared to CRF-treated patients. Furthermore, recurring pain was more commonly observed in PRF-treated patients. Therefore, CRF may be the preferred treatment option for TN, whereas treatment with PRF requires further study.