Trigeminal neuralgia (TN) is a chronic pain condition that affects the face, often causing sharp, electric shock-like pain in areas served by the trigeminal nerve. When medications are no longer effective, interventional procedures such as radiofrequency ablation (RFA) may be used. This retrospective study compares two different RFA techniques in patients with classical TN: (1) conventional thermal RFA applied to the Gasserian ganglion, and (2) pulsed RFA applied peripherally to the nerve branches.

The purpose of the study is to evaluate pain relief, patient satisfaction, and complication rates between these two commonly used techniques. A total of 60 patients aged 55-80 years, who were treated at the Mersin University Pain Clinic between January 2015 and June 2025, were included. The study uses clinical records and follow-up data to assess outcomes at 6 months post-procedure.

This study aims to provide clinicians with more evidence to guide the selection of safer and more effective treatments for trigeminal neuralgia, with the goal of improving patients' quality of life and reducing treatment-related side effects.

Trigeminal neuralgia (TN) is a debilitating neuropathic condition characterized by recurrent episodes of severe, lancinating facial pain in the distribution of one or more branches of the trigeminal nerve. Although most patients initially respond to medical therapy such as carbamazepine or oxcarbazepine, a subset remains refractory and requires interventional treatment.

Radiofrequency ablation (RFA) has been widely used in the management of refractory TN, especially conventional thermal RFA targeting the Gasserian ganglion. While this approach offers substantial pain relief, it may lead to complications such as facial numbness, dysesthesia, or weakness due to irreversible nerve damage. As an alternative, pulsed RFA (PRF) offers neuromodulation without causing structural nerve injury and is often preferred for peripheral branch interventions.

This retrospective cohort study aims to compare the effectiveness and safety of two RFA techniques in patients with classical TN:

Group A: Conventional RFA applied to the Gasserian ganglion

Group B: Pulsed RFA applied peripherally to the affected branch (V1, V2, or V3)

Patients were selected from the records of the Pain Clinic of Mersin University Faculty of Medicine between January 1, 2015, and June 1, 2025. A total of 60 patients aged 55-80 years, who had been diagnosed with classical TN (per ICHD-3 criteria), were included. All patients had failed medical management for at least 6 months and underwent either of the RFA techniques described above. Patients with secondary TN, prior craniofacial surgery, or missing follow-up data were excluded.

PRF was specifically chosen for peripheral interventions in our clinic to avoid thermal-related complications. PRF was applied at 42°C for two cycles of 120 seconds. Thermal RFA was applied with standard lesioning parameters following contrast-confirmed Gasserian ganglion targeting.

Outcome measures included:

Primary: Pain relief measured using a numerical rating scale (NRS) at baseline and 6 months post-procedure

Secondary: Patient satisfaction (5-point Likert scale), rate of complications, and recurrence of pain requiring reintervention

All procedures were performed under fluoroscopic guidance by experienced pain specialists. Data was extracted from electronic records and procedure reports. Statistical comparisons will be made using appropriate parametric or non-parametric tests based on data distribution.

This study seeks to contribute real-world evidence to guide clinicians in selecting safer, more effective RFA strategies for managing TN, particularly in patients at risk for complications or those preferring less invasive approaches.

Inclusion Criteria:

• Patients aged between 55 and 80 years with a diagnosis of classical trigeminal neuralgia according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Patients must have experienced pain refractory to medical management for at least 6 months and have complete clinical and procedural records available, including follow-up data for a minimum of 6 months.

Exclusion Criteria:

• Patients with secondary trigeminal neuralgia due to structural causes such as multiple sclerosis or tumors, those with a history of prior craniofacial surgery or neuroablative procedures, patients lacking sufficient follow-up data, and those with contraindications to sedation or with uncontrolled systemic comorbidities are excluded from the study.

De-identified individual participant data (IPD) related to primary and secondary outcomes will be shared upon reasonable request. Data will be available after publication and can be requested by contacting the principal investigator.

De-identified individual participant data and selected supporting documents will be available upon request beginning 6 months after publication. Data will remain available for 5 years.

Researchers affiliated with academic institutions may request access to anonymized individual participant data and related documents for non-commercial research. Requests must include a brief study proposal and will be reviewed by the principal investigator. Data will be shared via institutional email upon approval.

Participants and investigators know which intervention is being received.