- An accurate diagnosis is essential. Diagnosis is made by history. Be optimistic, caring and a good listener - There is no BEST procedure - treatment should be individualized. Medication should be tried first. - Dysesthesia may occur with all ablative procedures. Dysesthesia is not responsive to additional ablative procedures - Outcome of treatment worsens with chronicity. Repeat MVD surgery has greater risk & less success

1. KETUT NGURAH GUNAPRIYA MD FIPP
FK UB RSSA MALANG
TRIGEMINAL NEURALGIA
RADIOFREQUENCY ABLATION

12. INERVATION

13. TRIGEMINAL NERVE ANATOMY

14. FUNCTIONAL ANATOMY

15. PREVALENSI

16. AGE OF ONSET
0
5
10
15
20
25
30
2nd 3rd 4th 5th 6th 7th 8th 9th
Decade
More than 70% of patients with TN are over 50
years of age at the time onset

17. DISTRIBUTION OF PAIN BY DIVISION
32
17 17
15 14
4
0.4
0
5
10
15
20
25
30
35
Percent
V2,3 V2 V1,2,3 V3 V1,2 V1 V1,3
Trigeminal Division

18. DISTRIBUTION

21. DIAGNOSA

22. DIAGNOSA

23. DIAGNOSA

24. TREATMENT
• Medication
• Carbamezapine 400-800 mgday
• Gabapentin -900- 2400 mg/day
• Phenytoin – 300-500mg/day
• Oxcarbazepine – 900-1800mg/day
• Baclofen ( 5 mg orally 3 times a day for 3 days, then 10 mg orally 3
times a day for 3 days, then 15 mg orally 3 times a day for 3 days, then 20
mg orally 3 times a day. Maintenance dose: 40-80 mg/day. 80 mg/day doses
should be administered in 4 divided doses.)

26. CLINICAL PRACTICE ALGORITHM
Medication treatment gives
insufficient pain relief/ intolerable
side effects
Young patient
MVD
Elderly patient
RF

29. PATIENT SELECTION

30. OVERVIEW STEPS

34. SUBMENTAL VIEW OBLIQUE

35. Submental view: Approximately 30o caudal and 30o lateral
Needle directed towards foramen ovale

36. TUNNEL VISION

37. LATERAL VIEW

38. LATERAL VIEW

39. LATERAL VIEW

40. JUST ENTER FORAMEN OVALE

41. ENTER FORAMEN OVALE

42. FINAL POSITION

43. AP VIEW

45. Directed towards ipsilateral pupil in AP view and
midpoint of zygomatic arch in lateral view

50. WALKING THE BONE

52. CSF FLOW

54. CANULE RF

65. SUMMARY

66. DEDICATED to my beloved CHEETAH…