Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: A systematic review and meta-analysis


      • RFT of the peripheral nerves and the Gasserian ganglion both will have satisfactory pain relive.
      • Peripheral nerve ablation was associated with higher recurrent rate.
      • RFT of the Gasserian ganglion was associated with more complication.



      Trigeminal neuralgia is characterized by pain at the distribution of one or more of the trigeminal nerve branches and is usually treated with anti-epileptic medication. When first line treatment fails, patients receive other treatment modalities including radiofrequency thermoablation (RFT) of the Gasserian ganglion and peripheral branches of the trigeminal nerve. The aim of this study is to compare RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve in terms of efficacy and rate of complications.


      This was a systematic review and meta-analysis that searched Medline, Cochrane Central Register of Controlled Trials, and Embase using Medical Subject Headings and the references of the enrolled studies with no restriction on date. We included only RCTs that compared the RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve with one of the following outcomes: pain scales, immediate effective rate, recurrence rate, and complications.


      Five articles were eligible for our review and showed that there was no difference between RFT of the peripheral nerves and the Gasserian ganglion in terms of pain scores. There was a non-significant trend for RFT of the peripheral nerve to have higher immediate effect rates and higher recurrence rates. RFT of the Gasserian ganglion group was associated with masticatory weakness, while the other group was associated with facial swelling and numbness of V2.


      RFT of the peripheral branches is a safe and effective method to treat idiopathic trigeminal neuralgia but leads to a higher recurrence rate when compared with RFT of the Gasserian ganglion.



      TN (Trigeminal neuralgia), RFT (Radiofrequency thermoablation), MVD (Microvascular decompression), PRF (Peripheral nerves radiofrequency thermoablation), GPF (Gasserian ganglion radiofrequency thermoablation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.

        • Maarbjerg S.
        • Di Stefano G.
        • Bendtsen L.
        • Cruccu G.
        Trigeminal neuralgia - diagnosis and treatment.
        Cephalalgia. 2017; 37: 648-657
        • Lambru G.
        • Zakrzewska J.
        • Matharu M.
        Trigeminal neuralgia: a practical guide.
        Pract Neurol. 2021; 21: 392-402
        • Gronseth G.
        • Cruccu G.
        • Alksne J.
        • Argoff C.
        • Brainin M.
        • Burchiel K.
        • et al.
        Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies.
        Neurology. 2008; 71: 1183-1190
        • MacDonald B.K.
        • Cockerell O.C.
        • Sander J.W.
        • Shorvon S.D.
        The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK.
        Brain. 2000; 123: 665-676
        • Panchagnula S.
        • Sularz A.K.
        • Kahle K.T.
        Familial Trigeminal Neuralgia Cases Implicate Genetic Factors in Disease Pathogenesis.
        JAMA Neurol. 2019; 76: 9-10
        • Iwanaga J.
        • Badaloni F.
        • Laws T.
        • Oskouian R.J.
        • Tubbs R.S.
        Anatomic study of extracranial needle trajectory using Hartel technique for percutaneous treatment of trigeminal neuralgia.
        World Neurosurgery. 2018; 110: e245-e248
      2. Härtel F. Die Leitungsanästhesie und Injections-behandlung des Ganglion Gasseri und der Trigeminusstämme. Die Leitungsanästhesie und Injections-behandlung des Ganglion Gasseri und der Trigeminusstämme. Berlin, Heidelberg: Springer Berlin Heidelberg; 1913. p. 1-100.

      3. Sweet WG. Proceedings: Analgesia dolorosa after differential retrogasserian thermal or mechanical rhizotomy: tactics employed to decrease its influence. J Neurol Neurosurg Psychiatry. 1975;38(4):407.

        • Cheng J.S.
        • Lim D.A.
        • Chang E.F.
        • Barbaro N.M.
        A review of percutaneous treatments for trigeminal neuralgia.
        Operative Neurosurgery. 2013; 10: 25-33
        • Nugent G.R.
        Radiofrequency treatment of trigeminal neuralgia using a cordotomy-type electrode. A method.
        Neurosurg Clin N Am. 1997; 8: 41-52
        • Taha J.M.
        • Tew Jr., J.M.
        Treatment of trigeminal neuralgia by percutaneous radiofrequency rhizotomy.
        Neurosurg Clin N Am. 1997; 8: 31-39
        • Huang B.
        • Yao M.
        • Feng Z.
        • Guo J.
        • Zereshki A.
        • Leong M.
        • et al.
        CT-guided percutaneous infrazygomatic radiofrequency neurolysis through foramen rotundum to treat V2 trigeminal neuralgia.
        Pain Med. 2014; 15: 1418-1428
        • Zeng F.
        • Zhu M.
        • Wan Q.
        • Yan Y.i.
        • Li C.
        • Zhang Y.
        The treatment of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the foramen rotundum and foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation.
        Clin Neurol Neurosurg. 2020; 196: 106025
        • Wan Q.
        • Zhang D.
        • Cao X.
        • Zhang Y.
        • Zhu M.
        • Zuo W.
        CT-guided selective percutaneous radiofrequency thermocoagulation via the foramen rotundum for isolated maxillary nerve idiopathic trigeminal neuralgia.
        J Neurosurg. 2018; 128: 211-214
        • Zundert J.V.
        • Brabant S.
        • de Kelft E.V.
        • Vercruyssen A.
        • Buyten J.V.
        Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia.
        Pain. 2003; 104: 449-452
        • Barker 2nd, F.G.
        • Jannetta P.J.
        • Bissonette D.J.
        • Larkins M.V.
        • Jho H.D.
        The long-term outcome of microvascular decompression for trigeminal neuralgia.
        N Engl J Med. 1996; 334: 1077-1083
        • Al-Quliti K.W.
        Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options.
        Neurosciences (Riyadh). 2015; 20: 107-114
      4. Kanpolat Y, Savas A, Bekar A, Berk C. Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery. 2001;48(3):524-32; discussion 32-4.

        • Onofrio B.M.
        Radiofrequency percutaneous Gasserian ganglion lesions. Results in 140 patients with trigeminal pain.
        J Neurosurg. 1975; 42: 132-139
        • Erdine S.
        • Ozyalcin N.S.
        • Cimen A.
        • Celik M.
        • Talu G.K.
        • Disci R.
        Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia.
        Eur J Pain. 2007; 11: 309-313
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gøtzsche P.C.
        • Ioannidis J.P.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        Ann Intern Med. 2009; 151: W65-W94
      5. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Bmj. 2019;366:l4898.

      6. Hegab AS, Baha, a Khidr O. Distal versus proximal pulsed radiofrequency for treating trigeminal neuralgia. Research and Opinion in Anesthesia and Intensive Care. 2020;7(2):142-8.

        • Huibin Q.
        • Jianxing L.
        • Guangyu H.
        • Dianen F.
        The treatment of first division idiopathic trigeminal neuralgia with radiofrequency thermocoagulation of the peripheral branches compared to conventional radiofrequency.
        J Clin Neurosci. 2009; 16: 1425-1429
        • Bharti N.
        • Sujith J.
        • Singla N.
        • Panda N.B.
        • Bala I.
        Radiofrequency thermoablation of the gasserian ganglion versus the peripheral branches of the trigeminal nerve for treatment of trigeminal neuralgia: a randomized.
        Control Trial Pain Physician. 2019; 22: 147-154
        • Mira K.M.
        • Elnaga I.A.
        • el-Sherif H.
        Nerve cells in the intracranial part of the trigeminal nerve of man and dog. Anatomical study of the fifth cranial nerve.
        J Neurosurg. 1971; 34: 643-646
        • Guest J.
        • Santamaria A.J.
        • Benavides F.D.
        Clinical translation of autologous Schwann cell transplantation for the treatment of spinal cord injury.
        Curr Opin Organ Transplant. 2013; 18: 682-689
        • Martin D.
        • Robe P.
        • Franzen R.
        • Delree P.
        • Schoenen J.
        • Stevenaert A.
        • et al.
        Effects of Schwann cell transplantation in a contusion model of rat spinal cord injury.
        J Neurosci Res. 1996; 45: 588-597
        • Bendtsen L.
        • Zakrzewska J.M.
        • Abbott J.
        • Braschinsky M.
        • Di Stefano G.
        • Donnet A.
        • et al.
        European Academy of Neurology guideline on trigeminal neuralgia.
        Eur J Neurol. 2019; 26: 831-849
        • O'Callaghan L.
        • Floden L.
        • Vinikoor-Imler L.
        • Symonds T.
        • Giblin K.
        • Hartford C.
        • et al.
        Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England.
        J Headache Pain. 2020; 21: 130
        • Lemos L.
        • Fontes R.
        • Flores S.
        • Oliveira P.
        • Almeida A.
        Effectiveness of the association between carbamazepine and peripheral analgesic block with ropivacaine for the treatment of trigeminal neuralgia.
        J Pain Res. 2010; 3: 201-212
        • Taylor J.C.
        • Brauer S.
        • Espir M.L.
        Long-term treatment of trigeminal neuralgia with carbamazepine.
        Postgrad Med J. 1981; 57: 16-18
        • Sterman-Neto H.
        • Fukuda C.Y.
        • Duarte K.P.
        • Aparecida da Silva V.
        • Rodrigues A.L.L.
        • Galhardoni R.
        • et al.
        Balloon compression vs radiofrequency for primary trigeminal neuralgia: a randomized, controlled trial.
        Pain. 2021; 162: 919-929
        • Texakalidis P.
        • Xenos D.
        • Tora M.S.
        • Wetzel J.S.
        • Boulis N.M.
        Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: A systematic review and meta-analysis.
        Clin Neurol Neurosurg. 2019; 182: 112-122
        • Lopez B.C.
        • Hamlyn P.J.
        • Zakrzewska J.M.
        Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia.
        Neurosurgery. 2004; 54: 973-983
        • Zakrzewska J.M.
        • Jassim S.
        • Bulman S.J.
        A prospective, longitudinal study on patients with trigeminal neuralgia who underwent radiofrequency thermocoagulation of the Gasserian ganglion.
        Pain. 1999; 79: 51-58
        • Savas A.
        • Sayin M.
        Subarachnoid bleeding into the superior cerebellopontine cistern after radiofrequency trigeminal rhizotomy: case report.
        Acta Neurochir. 2010; 152: 561-562