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This is a description of what is called a radiofrequency lesion ("RFL" for short). This is a treatment for your condition that is called tic douloureux (French for "painful spasm"). It occurs most commonly when the nerve that travels to the face (called "the fifth nerve") is pressed on by an artery as it leaves the brain. Of the many options for this, an RFL has been recommended to you. Preparation for the Procedure: There is very little in the way of preparation for this procedure. The only request is that you eat nothing after midnight before the procedure. If you take medications in the morning, take them with a sip of water prior to leaving for the hospital.
Your day starts
with arrival in the Operating Room after having an intravenous placed.
When on the operating table, an X-ray machine will be positioned
next to you that assists us during the procedure. You will receive
one medication that will make you sleepy, and then another that
will put you completely asleep for about two or three minutes. During
that time, an approximately 2 ½ in. probe will be passed
through the cheek just to the side of the mouth. With the use of
the X-ray machine, we will guide it so that the tip ends in the
fibers of the nerve which is causing your discomfort.
After-effects of an RFL: It is important to know that an RFL will usually eliminate the pain, but at some cost. The intent is to give you numbness in the part of your face where you have been feeling pain. This numbness is annoying, but usually minimal and well tolerated. You may notice that your speech is slightly slurred, and this can last a few weeks before going away. You may also notice that the side of your tongue is numb and that you tend to bite it when eating. Some people
lose food on the inside of that cheek. You might not know it is
there because you cannot feel it. Again, this usually gets better
as time goes on because one gets used to it, and the numbness can
diminish over time.
It is important to note that this annoying numbness is almost always preferred to the excruciating pain it replaces. On rare occasion, however, people actually find that this numbness is more annoying than the pain it replaced. This is a rare medical condition called anesthesia dolorosa and can be difficult to treat when it occurs.
Complications of the RFL: The main complication that we have seen is that the numbness is either more extensive in intensity or location than desired. I am very careful in making sure the needle is in the correct fibers prior to treating them. However, even with the most careful preparation, sometimes the numbness can spread to other parts of the face. For example, we have had a few patients who had tic douloureux in the cheek. Despite careful placement of the needle and conservative creation of nerve fiber treatment, they developed numbness that spread to the forehead, eye, and chin as well. Although it is difficult to explain why, this can be extremely annoying, though in general is reasonably well tolerated. Other complications are extremely rare. In over 25 years of performing this procedure, in one instance, a patient developed an infection that spread into the temporal lobe that required prolonged antibiotics. Fortunately, this completely resolved. In another instance, the nerve treatment included fibers of a nerve that went to the eye. This resulted in double vision that also fortunately resolved in about two months. One undesirable feature of an RFL is that the pain often comes back. The cure rate is about 80%, but the pain can come back in a few weeks or up to 15 years. If it returns, the options are more medication, another RFL, or the below-described MVD. Alternatives: There are many alternatives to an RFL, but the most common is called a microvascular decompression (MVD for short). An MVD is a safe, but more extensive procedure involving at least 2 days in the hospital. It is done under general anesthesia, and involves making an incision behind the ear, and under a microscope identifying where the blood vessel is pressing on the nerve. The vessel is then gently separated from it with a small piece of material. This usually results in excellent pain relief, and its advantage is that there is generally no numbness as a result. Should you wish to speak to a neurosurgeon who specializes in this, I will gladly arrange this for you. Summary:
RFLs are extremely safe procedures. They are a desirable alternative
to open brain surgery done under general anesthesia, though they
are not for everyone. The success rate in terms of early relief
of pain is over 90 percent, but recurrence of the pain can occur.
There are risks, though are generally minor and uncommon. |
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Neurosurgery
Associates, Inc. email: questions@neurosurgery-associates.com Copyright ©2010 Neurosurgery Associates, Inc.
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Procedure: Radiofrequency
lesions take approximately 45 minutes, and are done as an outpatient.
This means that you come into the hospital and then leave on the
same day. 
During
that time, we will run a different form of electricity that will
treat the nerve fibers which are causing your pain. This will cause
them to be altered such that you will feel numbness in the part
of your face where you previously felt your pain. When you awake
again, we will test that part of your face with a safety pin. The
goal is that you are able to feel pressure, but that the sharpness
or prickiness of the needle is no longer felt. When we achieve this
goal, we are finished. The needle will be removed and a Band-Aid
placed on it. After a short stay in the Recovery Room, you will
head home.
