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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Radiofrequency thermocoagulation for trigeminal neuralgia in a sleep-awake procedure under neuromonitoring guidance

Perkutane Thermokoagulation für die Behandlung vonTrigeminusneuralgie im Schlaf-Wach-Verfahren unter Anleitungdes Neuromonitorings

Meeting Abstract

  • presenting/speaker Tammam Abboud - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Angelina Nazarenus - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV028

doi: 10.3205/20dgnc032, urn:nbn:de:0183-20dgnc0320

Published: June 26, 2020

© 2020 Abboud et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Radiofrequency thermocoagulation (RT) for the treatment of trigeminal neuralgia (TN) is a well-established technique. This procedure is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience for the patient, which diminishes the reliability of the patient’s response. Therefore, we applied a sleep-awake technique with placement of the RT canula under intraoperative monitoring, which might be a good alternative. We present our case series to investigate the feasibility und outcome of this technique.

Methods: We reviewed five cases of patients suffering from pharmacoresistent TN, whopreviously underwent a microsurgical decompression of the trigeminal nerve at least once. For RT, the patient underwent a short general anesthesia using a laryngeal tube in the supine position. Pairs of EMG-needles were implanted subdermally near the supraorbital, infraorbital, and mental foramina. Insertion of the radiofrequency cannula was done using typical anatomical landmarks under x-ray guidance. The trigeminal nerve roots were stimulated through the foramen ovale with the tip of the radiofrequency canula at 0.5 V, and antidromic sensory evoked responses were recorded from the 3 divisions of the trigeminal nerve as well as the mandibular muscle in the face. Repositioning of the cannula was performed until the desired nerve divisions could be stimulated. Afterwards, anesthesia was stopped, the laryngeal tube was removed and the stimulation was repeated (0.05-0.15V) to obtain a verbal response from the patient. Lesioning was performed with radiofrequency for 90 seconds at an intensity of 75°C.

Results: Antidromic sensory evoked potentials of all trigeminal nerve branches could be obtained in all five patients and repositioning of the cannula under stimulation enabled localizing of the desired branches (V2 and V3 in 3 patients and V2 in 2 patients). After awaking, patients confirmed the effect of stimulation at the face. Radiofrequency lesioning resulted in an immediate pain relief in all patients. Temporary hypalgesia in the territory of the lesioned branches occurred in all patients, but recovered during hospital stay.

Conclusion: In TN, RT of trigeminal nerve under neuromonitoring guidance in a sleep-awake modus is feasible and could be an alternative for uncooperative, anxious or even all patients. Antidromic sensory evoked potentials allowed an accurate localization of the involved branches of the trigeminal nerve.