# Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia

## TL;DR

This paper introduces a new method for a painful nerve treatment that uses monitoring and anesthesia to make the procedure more comfortable and precise.

## Contribution

The novel approach uses neuromonitoring and general anesthesia to accurately perform RFT for trigeminal neuralgia.

## Key findings

- Antidromic sensory-evoked potentials enable accurate localization of trigeminal branches during RFT.
- The procedure can now be performed under general anesthesia, reducing patient discomfort.
- The method improves the precision and safety of RFT for refractory trigeminal neuralgia.

## Abstract

Radiofrequency thermocoagulation (RFT) for refractory trigeminal neuralgia is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience. Here, we present RFT under neuromonitoring guidance and general anesthesia.

Stimulation of trigeminal branches at the foramen ovale with the tip of the RFT cannula is performed under short general anesthesia. Antidromic sensory–evoked potentials (aSEP) are recorded from the 3 trigeminal branches. The cannula is repositioned until the desired branch can be stimulated and lesioned.

aSEP enable accurate localization of involved trigeminal branches during RFT and allow performing the procedure under general anesthesia.

The online version contains supplementary material available at 10.1007/s00701-024-05964-9.