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You have been asked to consider a procedure called a radiofrequency lesion (RFL). 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, or trigeminal, nerve") is irritated by an artery pressing on it.

PREPARATION:  There is very little in the way of preparation for this procedure. You should not eat or drink anything after midnight before the day of the surgery. You will be instructed if you need to stop any medications prior to your surgery by our office staff, and which medications to take the morning of your procedure.

PROCEDURE: Radiofrequency lesions take approximately 45 minutes, and are done as an outpatient. When you come into the Operating Room, you will first enter the Holding Area. You will meet the nursing staff, the anesthesia staff, and have an intravenous placed. You will then be transported to the operating room. When on the operating table, an X-ray machine will be positioned next to you that assists us during the procedure. You will receive a medication that puts you completely asleep for about two or three minutes. During that time, an approximately 2 inch probe (see picture) will be passed through the cheek. 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 warmth 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 warmth in the part of your face where you feel your facial pain. 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 your cheek. After a short stay in the Recovery Room, you will be sent home.

AFTER EFFECTS OF AN RFL: It is important to know that an RFL will usually eliminate the pain, but will cause what is called sensory loss. 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. .

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. Also important to note is that once every year or two, I cannot properly position the probe. In that event, we stop the procedure and come back another day.

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.

Other complications are extremely rare. In over 30 years of performing this procedure, in one instance, two patients developed an infection that required prolonged antibiotics. Fortunately, these 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 relief 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 open surgery called a Microvascular Decompression.

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. The other is gamma knife which is a form of radiation.

Summary:  An RFL is an extremely safe procedure. It is a desirable alternative to open brain surgery, though it is not for everyone. There are risks, but they are generally minor and uncommon.

Stephen Saris, M.D.

Neurosurgery Associates, Inc.
1 Davol Square, Suite 302

Providence, Rhode Island 02903

(401) 453-3545

FAX (401) 453-3533

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Neurosurgery Associates
Neurosurgery Associates