Elvan ERHAN, Tülin ARICI, Mustafa KURCALOĞLU, Ertuğrul KILIÇ

Gasser ganglion blokajında pulse radyofrekans ile termokoagülasyon radyofrekansın kombine edilmesi

Amaç: Trigeminal nevralji (TN), gasserian ganglionun radyofrekans termokoagülasyonu (RFT) ile etkin bir şekilde tedavi edilmiştir. Son zamanlarda, pulse radyofrekans (PRF) trigeminal nevraljisi olan hastalar için alternatif bir tedavi haline gelmektedir. RFT ile PRF kombinasyonunun postoperatif komplikasyonları azaltıp azaltmadığı ve uzun süreli ağrıların giderilip giderilmediği belirsizdir. Gereç ve Yöntem: Gasser ganglionun kombine RFT ve PRF’si uygulanan idiopatik TN’lı 12 hasta değerlendirildi. PRF (42 °C, 45 V, 20 ms, 120 saniye) uygulandı ve daha sonra, Gasser gangliona RFT (65 °C, 90 saniye) yapıldı. Postoperatif ağrı rahatlaması ve komplikasyonları tedaviden 1, 6, 12 ve 24 ay sonra değerlendirildi. Ağrı için VAS 3 ve üzeri dikkate alındı. Bulgular: 10 hastada (%83.3) tedaviden 1 ay sonra ağrıda belirgin azalma varken, 6. ayda 8 hasta (%66.6), 12. ayda 5 hasta (%41.6) ve 24. ayda 2 hasta (%16.6) ağrısızdı. Hastaların 2’sinde ağrı rahatlaması yoktu (NRS ≥3) ve 24. ayda 2 hasta hala ağrısızdı. Ağrı rahatlama süresi ortalama 14 aydı. Bir hastada yaklaşık bir yıldır dilde uyuşma vardı, diğer hastalarda ise ciddi komplikasyonlar bildirilmedi. Sonuç: PRF ile RFT kombinasyonu, trigeminal nevraljinin postoperatif komplikasyonlarını ortadan kaldırabilir. RFT ve PRF tedavisini kombine etmenin yan etkilerin azaltılmasına hizmet edebileceğini ancak ağrıyı azaltmadığını belirtmek isteriz.

Radiofrequency thermocoagulation combined with pulsed radiofrequency for gasserian ganglion blockage

Objectives: Trigeminal neuralgia (TN) has been effectively treated by radiofrequency thermocoagulation (RFT) of the gasserian ganglion. Recently, pulsed radiofrequency (PRF) is becoming an alternative therapy for patients with trigeminal neuralgia.It is unclear whether the combination of RFT with PRF may decrease post-operative complications while maintaining longterm pain relief.Methods: Twelve patients with idiopathic TN who had undergone combined RFT and PRF of the gasserian ganglion wereevaluated. PRF (42 °C, 45V, 20 ms, 120 seconds) was administered, and then RFT (65 °C, 90 seconds) was performed to the gasserian ganglion. The post-operative pain relief and complications were evaluated at 1, 6, 12 and, 24 months after treatment.Results: 10 patients (83.3%) reported significant pain relief (VAS 3) at 1 month following the treatment, while 8 patients(66.6%) at 6 months, 5 patients (41.6) at 12 months, and 2 patients (16.6%) at 24 months were pain-free. Two of the patients didnot have pain relief (VAS ≥3), and 2 patients were still pain-free by the 24th month. The mean time of pain relief was 14 months.One patient had numbness in the tongue for about a year, while in the other patients, no serious complications were reported.Conclusion: A combination of RFT with PRF could help eliminate postoperative complications of trigeminal neuralgia. Wesugesst that combining RFT and PRF therapy may serve to decrease the side effects but not increase the pain relief.

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