PATIENTS' GUIDE TO THE RFL
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
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.
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.
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. .
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
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.
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.
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.