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Radiofrequency Rhizotomy (RFR) For Trigeminal Neuralgia (6035)

Radiofrequency Rhizotomy (RFR) For Trigeminal Neuralgia (6035) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Neuro, Rehab


Radiofrequency Rhizotomy (RFR)
For Trigeminal Neuralgia

Your doctor has determined that your facial pain is due to trigeminal neuralgia. Medicines are
no longer working well in treating this pain. You have discussed alternative treatments with
your doctor. Your doctor has advised that a radiofrequency rhizotomy may meet your needs.

To understand trigeminal neuralgia and RFR treatment, it is helpful to know what the trigeminal
nerve does. There are two such nerves. One is on the left side and one is on the right side of the
face. Each nerve has two functions: motor and sensory. The sensory portion has three major
divisions. See the picture on page 5.

 V1 transmits feeling from the forehead, eye, and along the crest of the nose.
 V2 transmits feeling from the rest of the nose, the cheek, upper jaw, teeth, gum, lip, and
the hard palate.
 V3 transmits feeling from the lower jaw, teeth, gum, lip, tongue, temple, and ear canal.
V3 also has motor nerves that control the muscles of chewing.

Finding which division is the source of your pain is a major part in planning your treatment.
Sometimes, finding the correct division is complex. Having a trigger point can be a helpful clue.
A trigger point is a very sensitive spot on your face or in your mouth. If touched by finger or
tongue, it will often trigger a pain. Knowledge of a trigger point is helpful because it tells us
which division is causing your pain. Of course, pain can also be caused by less precise actions
such as chewing, talking, shaving, swallowing, brushing teeth, and wind or water on the face.
These provocative factors are of limited use in finding the site where your pain starts.

What is RFR and How May It Help You?

Radiofrequency Rhizotomy (RFR) is a treatment to relieve pain. It is most often done by a
neurosurgeon in a hospital radiology suite. During the procedure, the neurosurgeon works with
an anesthesiologist. This is because parts of the procedure require the patient asleep and other
parts require the patient awake. For instance, while you are asleep, the neurosurgeon will insert
a special needle, under x-ray guidance, through the skin of your cheek (see picture). Then, the
needle goes though a natural opening base, called the foramen ovale (labeled FO in picture), and
comes to lie where the three nerve divisions meet (labeled G in the picture).

The next step is to guide the needle tip to the division that is causing your pain. Your help is
needed in finding this division. For this part you will need to be awake. As the neurosurgeon
searches for this target he will pass a tiny electric current through the needle tip. In response,
you will feel a tingling in a small area on your face. When you tell the surgeon that the tingle is
right where your usual face pain is located, the target has been found.


Once this spot is found, you are put back to sleep with a short acting drug. While you are asleep,
the surgeon passes a heating (radiofrequency) current through the needle tip. This destroys the
nerve fibers that carry the painful messages. You are awakened again. Then, you are tested to
see whether your pain site is slowly being replaced by numbness. This nerve fiber destruction is
repeated until the surgeon is satisfied with the degree of facial numbness and the absence of pain.

Before the Procedure

Please stop all non-steroidal, anti-inflammatory medicines (such as naproxen, Advil®, or aspirin)
and blood thinners (such as Coumadin®, Plavix®, or aspirin, or vitamin E) more than a week
before surgery.

Before your RFR you will see the neurosurgery nurse practitioner. She will complete a health
history and physical exam. She will also answer questions that you might not have asked your
doctor. That same day, you will have routine blood tests, an electrocardiogram, and a chest x-
ray. The day before your RFR, a nurse from the hospital will call and tell you what time to
report to the Care Initiation Unit on the 4th floor. Remember, after midnight you cannot eat or
drink except a sip of water for your medicines. You should take your usual medicines (including
Tegretol® or Dilantin®) with small sips of water on the morning of the RFR. You should not
wear any facial or eye make up on the day of the procedure.

The Procedure

From the Care Initiation Unit you will be brought to the x-ray procedure room on the 3rd floor.
Staff will help you onto the x-ray table. You will be lying on your back. Your arms and legs
will be gently secured on the padded x-ray table. You will be given medicines through an IV
during the times you need to be asleep. You will be given oxygen through nasal prongs to aid
your breathing.

After the Procedure

You will recover in the Care Initiation Unit (4th Floor) for 2 to 4 hours. Most often, patients go
home the same day. We are able to keep patients overnight if that is needed. When you are
ready, you may have food and liquids as you wish. Take special care to protect the numb side of
your face. (See the section on Care At Home). As soon as you are able to drink enough fluids,
your IV will be removed.

If you have been taking medicines such as Dilantin® or Tegretol® your dosage will be decreased
slowly over a few days. Your doctor will write out a schedule for decreasing the dosage. Your
nurse will discuss this with you and answer any questions you might have. The dosage must be
tapered slowly. Please do not stop taking your medicine all of a sudden.

Pain Relief and Complications

In cases of typical trigeminal neuralgia, 95% of patients have pain relief right away. Pain recurs
in about 20% of patients in 6 years. The length of relief depends on the depth of the numbness.
Recurrence can be treated again with medicines, and later, with repeat RFR as needed.

All procedures carry the risk of complications. In the case of RFR, unpleasant facial numbness
is one. Although, some degree of facial numbness is needed for any pain relief, at rare times,
patients may find that the numbness that they have after the RFR bothers them more than the
original pain itself. Sometimes, the numbness may extend to the covering (cornea) of the eye.
The corneal reflex will be absent. This leaves the patient at risk of injuring the eye surface
without knowing it (see more below). The risk of other complications such as chewing
problems, infection, bleeding, double vision, stroke, anesthesia dolorosa (a severe constant
burning pain) or death is low, but not zero. The doctor will explain these risks and others to you
in more detail before the RFR.

Care at Home

Because the feeling in your face is decreased or absent you may not be able to feel pain, heat,
cold, or something touching your face. At first, this loss of feeling will seem strange. It may
feel like part of your face is swollen, but your mirror will show you that the swelling is minor.
You will slowly adjust to this loss of feeling.

You should take special safety measures to protect the numb side of your face. Check the
temperatures of water and food with the other side of your face or mouth first. This is important
since you will not be able to judge hot and cold on the numb side of your face. Chew on the
opposite side of your jaw to avoid biting your numb cheek.

Check your lips often to wipe off food particles you may not be able to feel. Check your mouth
after meals for sores (from teeth bites) or food particles (caught in your teeth). They may cause
irritation or infection. Brush your teeth carefully after each meal. You should see your dentist
for routine check-ups every six months. Since the numb side of your face will not be able to feel
hot or cold, extreme weather conditions are a danger to you. You may have to guard against
frostbite and sunburn.

Eye Care in the Case of Absent Corneal Reflex

The doctor may tell you that the corneal reflex in your eye is absent. This was mentioned under
“complications” above. Normally, this reflex makes you blink and tear when the eye is irritated.
Since you cannot feel eye irritation, you will need to check your eye for signs of irritation several
times a day. Your doctor may order eye drops to keep your eye moist. A nurse will show you
how to use the eye drops before you leave the hospital. Sometimes, feeling returns in the eye. If
this happens, you will be able to feel the eye drops going onto your eye. You may stop using the
drops if feeling returns to your eye.


Follow-Up Care

Your doctor wants you to return for a check-up visit. It will be set up for you before you leave
the hospital.

When to Call the Clinic

Call if you have:
ξ Increasing headache not relieved by Tylenol®.
ξ New onset confusion, stiff neck, or fever above 100.5 θF.
ξ Increased swelling, redness, and pain in the cheek or needle entry site.
These could be signs of infection or internal bleeding.

Phone Numbers

During the first three days after surgery, call the neurosurgery nurse practitioner at
(608) 263-1410

At night, call the emergency room at (608) 262-2398.

If you live out of the area, call toll-free at 1-800-323-8942.

Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 2/2015 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6035