Analysis of the Hemodynamic Response During Radiofrequency Thermocoagulation in Trigeminal Neuralgia

Abstract

Background: Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an excellent treatment option for medically intractable trigeminal neuralgia. However, this procedure can manifest abrupt changes in cardiovascular responses. With abrupt cardiovascular changes, a sudden trigeminocardiac reflex can occur during RFT of the trigeminal ganglion.

Objectives: The primary endpoint of this study was to identify the critical point at which RFT causes abrupt hemodynamic response changes. The secondary endpoint of this study was to evaluate the occurrence of the trigeminocardiac reflex.

Study design: Retrospective design.

Setting: An interventional pain management practice in The Republic of Korea (South Korea).

Methods: Forty patients who received trigeminal ganglion RFT under C-arm guidance due to intractable facial pain were included. We checked and recorded the blood pressure and heart rate at baseline (before RFT), immediately before and after entering the foramen ovale (FO), during electrical stimulation, during thermal heating, and 30 minutes post-RFT. Also, we recorded the presence or absence of the trigeminocardiac reflex during RFT.

Results: Heart rate during thermal heating increased more than 20% compared to baseline (87.6 beats/min vs 69 beats/min, P < 0.001). The mean arterial pressure showed an increase of more than 15% compared to baseline when the cannula entered the FO (106.4 mmHg vs 90.9 mmHg, P < 0.001) and during thermal heating (106.3 mmHg vs 90.9 mmHg, P < 0.001). Sudden bradycardia was observed in 25% (10/40) of the patients. Among 10 patients who showed sudden bradycardia, it was observed when the cannula entered the FO (15%, 6/40), during electrical stimulation (5%, 2/40), and during heating (5%, 2/40).

Limitations: This study included 40 patients who received trigeminal ganglion RFT, which is a low number to clarify the real incidence of the trigeminocardiac reflex during RFT.

Conclusion: FO puncturing, electrical stimulation, and thermal heating demonstrated an abrupt increase in heart rate and mean arterial pressure. The incidence of sudden bradycardia during RFT of the trigeminal ganglion was 25%. Most cases of bradycardia were observed during FO puncturing.