521: C-Arm Guided Radiofrequency Ablation for Refractory Idiopathic Trigeminal Neuralgia: Case Outcome

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Assessment and Measurement of Pain/Nociception, Treatment/management , Imaging (e.g. fMRI, PET, MRS)

Background and Aims: Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder that significantly affected quality of life. In trigeminal neuralgia, pain arises from the demyelination of trigeminal fibers, which triggers ectopic impulses and ephaptic transmission, leading to severe paroxysmal pain. Although medication is still becoming the first-line therapy, long-term medication may induce significant adverse effects, thus requiring further intervention.

Methods: We report a 55-year-old woman with a 15-year history of chronic trigeminal neuralgia affecting the V2 and V3 divisions. Diagnosis was confirmed clinically and supported by neuroimaging excluding neurovascular compression. Pharmacological management with anticonvulsants and antidepressants yielded minimal relief and complications of elevated liver enzymes. Consequently, C-arm-guided percutaneous radiofrequency ablation was performed. The procedure targeted the Gasserian ganglion within Meckel’s cave. A radiofrequency cannula was advanced through the foramen ovale, where a controlled thermal lesion (60–70 °C) was applied to disrupt pain fiber conduction, providing a localized intervention for refractory symptoms.

Results: After the radiofrequency ablation procedure, the patient experienced a significant reduction in pain intensity with restoration of sleep and daily activities. The pre-procedural pain score was NRS 10, which decreased to NRS 0 following RFA. No complications were observed in this patient.

Conclusions: C-arm–guided radiofrequency ablation of the Gasserian ganglion represent safe and effective interventional option for patients with refractory idiopathic trigeminal neuralgia, particularly in those who experience medication intolerance or long-term adverse effects. The case highlights the importance of timely transition from pharmacologic to interventional pain management in neuropathic facial pain.

References: [1] Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol 2021;21:392–402. https://doi.org/10.1136/practneurol-2020-002782.
[2] Dong B, Xu R, Lim M. The pathophysiology of trigeminal neuralgia: a molecular review. J Neurosurg 2023;139:1471–9. https://doi.org/10.3171/2023.2.JNS23274.
[3] Van Kleef M, Wilco ;, Van Genderen E, et al. EVIDENCE BASED MEDICINE 1. Trigeminal Neuralgia 2009. https://doi.org/10.1111/j.1533-2500.2009.00298.x.

Presenting Author: Hesti Heptaningrum
Submitting Author: Hesti Heptaningrum

Senior Author: Hesti Heptaningrum

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Henry Riyanto Sofyan: Neurologist Consultant - Department of Neurology, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Jakarta, Indonesia
• Tiara Aninditha: Neurologist Consultant - Department of Neurology, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo, Jakarta, Indonesia