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PATIENTS' GUIDE TO THE RFL

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.

Procedure: Radiofrequency lesions take approximately 45 minutes, and are done as an outpatient. The 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.

When you awake from the medication we have given you, we will run a small amount of electricity into the probe. You will feel a buzzing or warmness either in the chin, the cheek, or the forehead. It is vital that you relay to us precisely where you feel this because these are the same nerve fibers that are causing your pain. We might re-position the needle several times so that you get the buzzing or warmness in the part of your face where you feel your tic douloureux. We will then put you back to sleep for another few minutes.

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 prickliness 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.

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 standard placement of the needle and conservative 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 many 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 that specializes in this, I will 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. There are risks, though are generally minor and uncommon.


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Stephen Saris, M.D.

Neurosurgery Associates, Inc.
1 Davol Square, Suite 302

Providence, Rhode Island 02903


(401) 453-3545

FAX (401) 453-3533

email: contact@neurosurgery-associates.com

Copyright 2013 Neurosurgery Associates, Inc.

Neurosurgery Associates
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