Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report

Abstract

BackgroundTrigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation.Case presentationA 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months.DiscussionTrigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible, therefore, an unusual combination of infratrochlear, supratrochlear, and lacrimal radiofrequency thermocoagulation was implemented for this patient.ConclusionsRadiofrequency thermocoagulation is an effective treatment option for trigeminal neuralgia. Peripheral branch radiofrequency thermocoagulation for trigeminal neuralgia should be considered preferentially due to its minimal invasiveness and convenience. Furthermore, as the sensory innervation of the upper eyelid is complex, the knowledge of peripheral distribution of trigeminal nerve is essential.

Radiofrequency thermocoagulation in cases of atypical trigeminal neuralgia: a retrospective study

“…Similarly, in our study, RF showed high efficiency (p < 0.05) in pain relief in 16 patients and only 3 patients (21%) did not reach our required > 50% pain improvement in VAS score. Few previous case reports revealed similar results in cases of atypical TN [14,15].…”

“…Patients with typical TN usually respond to RF ablation [7][8][9][10][11][12][13]. Yet, limited studies have addressed the efficacy of RF in cases with atypical trigeminal neuralgia [14,15]. The aim of this study is to examine the effects of RF ablation in cases with atypical TN that did not respond to standard medical treatments.…”

Immediate and Long-Term Outcomes of Microvascular Decompression for Mixed Trigeminal Neuralgia

“…3,11 Other methods have subsequently been attempted to treat atypical facial pain symptoms in particular with a variety of methods, including sphenopalatine ganglion blockade and ophthalmic branch radiofrequency thermocoagulation. 12,13…”