Radiofrecuencia convencional y pulsada armonizada en el ganglio de Gasser para el tratamiento de la neuralgia del trigémino: resultados del protocolo Dolomedic

CRITICAL CARE & EMERGENGY MEDICINE VOL. 6

Conventional and harmonized pulsed radiofrequency of the Gasserian ganglion for trigeminal neuralgia: results of the Dolomedic protocol

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www.doi.org/10.58281/ccem.v6i2.8

Francisco Javier Machuca Vigil 1 , Rafael Orlando Vallejo Estrella 1 , Roberto Jameson Rosales 2 , Francesca Dolciami 3 , Eduardo Perez Lozano 4 .

1 Algólogo intervencionista, FIPP, Dolomedic Alta Especialidad en Manejo del Dolor, H. Matamoros, Tamaulipas, México.
2 Algólogo intervencionista.
3 Médico Cirujano, Perugia, Italia.
4 Medico Pasante del Servicio Social. Unidad Médica de Alta especialidad “Dr. Antonio Fraga Mouret”. Centro Medico Nacional “La Raza”.

Abstract

Objectives: To describe the experience with the Dolomedic protocol, which combines conventional radiofrequency (CRF) and harmonized pulsed radiofrequency (PRF) of the Gasserian ganglion, for the treatment of refractory trigeminal neuralgia.

Material and Methods: A retrospective study was conducted in 77 patients with unilateral type 1 and 2 trigeminal neuralgia treated between July 2020 and July 2025 at Dolomedic Alta Especialidad (Heroica Matamoros, Mexico). The percutaneous approach to the Gasserian ganglion was performed under fluoroscopic guidance, applying a sequential protocol that integrates sublesive PRF (44 °C, 440 s, 40 ms, 4 Hz), escalated CRF (60–70 °C, 440 s) and a second PRF cycle. All patients received perineural dexamethasone. Clinical characteristics and pain evolution were assessed using the visual analogue scale (VAS) in the preoperative period and up to 60 months of follow-up.

Results: The sample included 53 women (68.8%) and 24 men (31.2%). The most frequent etiology was neurovascular compression (67.5%), followed by structural lesions (23.4%) and idiopathic cases (9.1%). The most frequently involved branches were V2 (44.2%) and V3 (40.3%). Baseline VAS was ≥ 8 in all groups. After the intervention, a significant reduction was observed, with VAS ≤ 2 from the first month, maintained throughout follow-up in both sexes, all etiologies and affected branches. Mild and transient adverse effects were reported: facial paresthesias in 18 patients and intraoperative bradyarrhythmia in 9, resolved without sequelae. No major complications were observed.

Conclusions: The combination of CRF and harmonized PRF is an effective and safe technique for the treatment of refractory trigeminal neuralgia, with sustained pain control up to five years and a low incidence of adverse effects.

Objetivos: Describir la experiencia con el protocolo Dolomedic, que combina radiofrecuencia convencional (CRF) y radiofrecuencia pulsada (PRF) armonizada en el ganglio de Gasser, para el tratamiento de la neuralgia del trigémino refractaria.

Material y Métodos: Se realizó un estudio retrospectivo en 77 pacientes con NT tipo 1 y 2 unilateral, tratados entre julio de 2020 y julio de 2025 en Dolomedic Alta Especialidad (H. Matamoros, México). El abordaje percutáneo del ganglio de Gasser se efectuó bajo fluoroscopia, aplicando un protocolo secuencial que integra PRF sublesiva (44 °C, 440 s, 40 ms, 4 Hz), CRF escalonada (60–70 °C, 440 s), y un segundo ciclo de PRF. Todos los pacientes recibieron dexametasona perineural. Se evaluaron características y evolución del dolor mediante escala visual análoga (EVA) en preoperatorio y hasta 60 meses de seguimiento.

Resultados: La muestra incluyó 53 mujeres (68.8%) y 24 hombres (31.2%). La etiología más frecuente fue compresión neurovascular (67.5%), seguida de lesiones estructurales (23.4%) e idiopáticas (9.1%). Las ramas más comprometidas fueron V2 (44.2%) y V3 (40.3%). El EVA basal promedio fue ≥ 8 en todos los grupos. Tras la intervención, se observó reducción significativa con EVA ≤ 2 desde el primer mes, mantenida durante todo el seguimiento en ambos géneros, todas las etiologías y ramas afectadas. Se reportaron efectos adversos leves y transitorios: parestesias faciales en 18 pacientes y bradiarritmia intraoperatoria en 9, resuelta sin secuelas. No hubo complicaciones mayores.

Conclusiones: La combinación de CRF y PRF armonizada constituye una técnica eficaz y segura para el tratamiento de la NT refractaria, con control del dolor sostenido hasta cinco años y mínima incidencia de efectos adversos.

Trigeminal Neuralgia; Trigeminal Ganglion; Radiofrequency
Therapy; Pulsed Radiofrequency Treatment; Chronic Pain.

Francisco Javier Machuca Vigil 
Algólogo intervencionista, FIPP, Dolomedic Alta Especialidad en Manejo del Dolor, H. Matamoros, Tamaulipas, México.

Rafael Orlando Vallejo Estrella 
Algólogo intervencionista, FIPP, Dolomedic Alta Especialidad en Manejo del Dolor, H. Matamoros, Tamaulipas, México.

Roberto Jameson Rosales 
Algólogo intervencionista.

Francesca Dolciami 
Médico Cirujano, Perugia, Italia.

Eduardo Perez Lozano 
Medico Pasante del Servicio Social. Unidad Médica de Alta especialidad “Dr. Antonio Fraga Mouret”. Centro Medico Nacional “La Raza”.

  1. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia. 2017;37(7):648-657. DOI: 10.1177/0333102416687280

  2. Jia Y, Chen Z, Ren H, Luo F. Effectiveness and safety of high-voltage pulsed radiofrequency in primary trigeminal neuralgia: A multicenter, randomized, double-blind clinical trial. J Headache Pain. 2023;24(1):96. DOI: 10.1186/s10194-023-01629-7

  3. Wu H, Zhou J, Chen J, Gu Y, Shi L, Ni H. Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. J Pain Res. 2019;12:423-441. DOI: 10.2147/JPR.S176960

  4. de León Casasola O, Martínez-Lage JF, García R, et al. Percutaneous bipolar thermal radiofrequency ablation of the Gasserian ganglion for trigeminal neuralgia: clinical results in a multicenter study. Pain Physician. 2019;22(5):E445-E454.

  5. Elawamy A, Abd-Elsayed A, Shehata T, Alrefaey K. Pulsed radiofrequency of Gasserian ganglion versus conventional radiofrequency and combined pulsed and conventional radiofrequency for the treatment of trigeminal neuralgia. Pain Physician. 2017;20(7):E873-E881.

  6. Cahana A, Vutskits L, Muller D. Pulse radiofrequency: current clinical and biological literature available. Pain Med. 2006;7(5):411-423. DOI: 10.1111/j.1526-4637.2006.00148.x

  7. Calamassi D, Lucicesare A, Pomponi GP, et al. Listening to music tuned to 440 Hz versus 432 Hz to reduce anxiety and stress in emergency nurses during the COVID-19 pandemic: a randomized controlled pilot study. Acta Biomed. 2022;93(5):e2022247. DOI: 10.23750/abm.v93i5.13138

  8. Arnold CA, Dick M, De Jonge M, et al. The psychophysiology of music-based interventions and pain perception: a comprehensive review. Front Psychol. 2024;15:1361857. DOI: 10.3389/fpsyg.2024.1361857

  9. Ren H, Zhao C, Wang X, Shen Y, Luo F. The efficacy and safety of the application of pulsed radiofrequency, combined with low-temperature continuous radiofrequency, to the Gasserian ganglion for the treatment of primary trigeminal neuralgia: study protocol for a prospective, open-label, parallel, randomized controlled trial. Pain Physician. 2021;24(1):89–97.

     

  10. Li H, Ding Y, Zhu Y, Han Z, Yao P. Effective treatment of postherpetic neuralgia at the first branch of the trigeminal nerve by high-voltage pulsed radiofrequency: a prospective study. Front Neurol. 2021;12:746035. DOI: 10.3389/fneur.2021.746035

  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349. doi:10.1016/j.jclinepi.2007.11.008

  12. Zhao C, Ren H, Shrestha N, Meng L, Shen Y, Luo F. The efficacy of combining pulsed radiofrequency with low-temperature continuous radiofrequency for primary trigeminal neuralgia: a randomized controlled trial. J Neurosurg. 2025;143(1):100-110. DOI: 10.3171/2024.10.JNS241274

  13. Zhou G, Li H, Li Y, et al. Combination of pulsed radiofrequency with continuous radiofrequency thermocoagulation in V2/V3 primary trigeminal neuralgia: randomized controlled trial. Pain Physician. 2018;21(7):E545-E554.

  14. Li LM, et al. Efficacy of high-voltage, long-duration pulsed radiofrequency stimulation in patients with neuropathic pain. ePain. 2024. DOI: 10.3344/kjp.23324

  15. Wang Y, et al. Efficacy and safety of high-voltage vs standard-voltage PRF in neuropathic pain: meta-análisis reciente. J Pain Res. 2024. doi.org/10.2147/JPR.S439909

  16. Jorge DMF, et al. The mechanism of action between pulsed radiofrequency pertaining to pain relief: roles of cytokines, calcium, y modulación neuronal. Int J Mol Sci. 2022;23(19):11726. DOI: 10.3390/ijms231911726

[1] Machuca Vigil FJ, Jameson Rosales R, Orlando Vallejo R, Dolciami F, Perez Lozano E. Radiofrecuencia convencional y pulsada armonizada en el ganglio de Gasser para el tratamiento de la neuralgia del trigémino: resultados del protocolo Dolomedic. CC&EM [Internet]. [citado 25 de agosto de 2026];6(2):1-9. Disponible en:
https://criticalcareandemergencymedicine.com/OJS/index.php/inicio/article/view/8
PDF

Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

www.doi.org/10.58281/ccem.v6i2.8

Francisco Javier Machuca Vigil 1 , Rafael Orlando Vallejo Estrella 1 , Roberto Jameson Rosales 2 , Francesca Dolciami 3 , Eduardo Perez Lozano 4 .

1 Algólogo intervencionista, FIPP, Dolomedic Alta Especialidad en Manejo del Dolor, H. Matamoros, Tamaulipas, México.
2 Algólogo intervencionista.
3 Médico Cirujano, Perugia, Italia.
4 Medico Pasante del Servicio Social. Unidad Médica de Alta especialidad “Dr. Antonio Fraga Mouret”. Centro Medico Nacional “La Raza”.

Abstract

Objectives: To describe the experience with the Dolomedic protocol, which combines conventional radiofrequency (CRF) and harmonized pulsed radiofrequency (PRF) of the Gasserian ganglion, for the treatment of refractory trigeminal neuralgia.

Material and Methods: A retrospective study was conducted in 77 patients with unilateral type 1 and 2 trigeminal neuralgia treated between July 2020 and July 2025 at Dolomedic Alta Especialidad (Heroica Matamoros, Mexico). The percutaneous approach to the Gasserian ganglion was performed under fluoroscopic guidance, applying a sequential protocol that integrates sublesive PRF (44 °C, 440 s, 40 ms, 4 Hz), escalated CRF (60–70 °C, 440 s) and a second PRF cycle. All patients received perineural dexamethasone. Clinical characteristics and pain evolution were assessed using the visual analogue scale (VAS) in the preoperative period and up to 60 months of follow-up.

Results: The sample included 53 women (68.8%) and 24 men (31.2%). The most frequent etiology was neurovascular compression (67.5%), followed by structural lesions (23.4%) and idiopathic cases (9.1%). The most frequently involved branches were V2 (44.2%) and V3 (40.3%). Baseline VAS was ≥ 8 in all groups. After the intervention, a significant reduction was observed, with VAS ≤ 2 from the first month, maintained throughout follow-up in both sexes, all etiologies and affected branches. Mild and transient adverse effects were reported: facial paresthesias in 18 patients and intraoperative bradyarrhythmia in 9, resolved without sequelae. No major complications were observed.

Conclusions: The combination of CRF and harmonized PRF is an effective and safe technique for the treatment of refractory trigeminal neuralgia, with sustained pain control up to five years and a low incidence of adverse effects.

Objetivos: Describir la experiencia con el protocolo Dolomedic, que combina radiofrecuencia convencional (CRF) y radiofrecuencia pulsada (PRF) armonizada en el ganglio de Gasser, para el tratamiento de la neuralgia del trigémino refractaria.

Material y Métodos: Se realizó un estudio retrospectivo en 77 pacientes con NT tipo 1 y 2 unilateral, tratados entre julio de 2020 y julio de 2025 en Dolomedic Alta Especialidad (H. Matamoros, México). El abordaje percutáneo del ganglio de Gasser se efectuó bajo fluoroscopia, aplicando un protocolo secuencial que integra PRF sublesiva (44 °C, 440 s, 40 ms, 4 Hz), CRF escalonada (60–70 °C, 440 s), y un segundo ciclo de PRF. Todos los pacientes recibieron dexametasona perineural. Se evaluaron características y evolución del dolor mediante escala visual análoga (EVA) en preoperatorio y hasta 60 meses de seguimiento.

Resultados: La muestra incluyó 53 mujeres (68.8%) y 24 hombres (31.2%). La etiología más frecuente fue compresión neurovascular (67.5%), seguida de lesiones estructurales (23.4%) e idiopáticas (9.1%). Las ramas más comprometidas fueron V2 (44.2%) y V3 (40.3%). El EVA basal promedio fue ≥ 8 en todos los grupos. Tras la intervención, se observó reducción significativa con EVA ≤ 2 desde el primer mes, mantenida durante todo el seguimiento en ambos géneros, todas las etiologías y ramas afectadas. Se reportaron efectos adversos leves y transitorios: parestesias faciales en 18 pacientes y bradiarritmia intraoperatoria en 9, resuelta sin secuelas. No hubo complicaciones mayores.

Conclusiones: La combinación de CRF y PRF armonizada constituye una técnica eficaz y segura para el tratamiento de la NT refractaria, con control del dolor sostenido hasta cinco años y mínima incidencia de efectos adversos.

Trigeminal Neuralgia; Trigeminal Ganglion; Radiofrequency
Therapy; Pulsed Radiofrequency Treatment; Chronic Pain.

Francisco Javier Machuca Vigil 
Algólogo intervencionista, FIPP, Dolomedic Alta Especialidad en Manejo del Dolor, H. Matamoros, Tamaulipas, México.

Rafael Orlando Vallejo Estrella 
Algólogo intervencionista, FIPP, Dolomedic Alta Especialidad en Manejo del Dolor, H. Matamoros, Tamaulipas, México.

Roberto Jameson Rosales 
Algólogo intervencionista.

Francesca Dolciami 
Médico Cirujano, Perugia, Italia.

Eduardo Perez Lozano 
Medico Pasante del Servicio Social. Unidad Médica de Alta especialidad “Dr. Antonio Fraga Mouret”. Centro Medico Nacional “La Raza”.

  1. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia. 2017;37(7):648-657. DOI: 10.1177/0333102416687280

  2. Jia Y, Chen Z, Ren H, Luo F. Effectiveness and safety of high-voltage pulsed radiofrequency in primary trigeminal neuralgia: A multicenter, randomized, double-blind clinical trial. J Headache Pain. 2023;24(1):96. DOI: 10.1186/s10194-023-01629-7

  3. Wu H, Zhou J, Chen J, Gu Y, Shi L, Ni H. Therapeutic efficacy and safety of radiofrequency ablation for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. J Pain Res. 2019;12:423-441. DOI: 10.2147/JPR.S176960

  4. de León Casasola O, Martínez-Lage JF, García R, et al. Percutaneous bipolar thermal radiofrequency ablation of the Gasserian ganglion for trigeminal neuralgia: clinical results in a multicenter study. Pain Physician. 2019;22(5):E445-E454.

  5. Elawamy A, Abd-Elsayed A, Shehata T, Alrefaey K. Pulsed radiofrequency of Gasserian ganglion versus conventional radiofrequency and combined pulsed and conventional radiofrequency for the treatment of trigeminal neuralgia. Pain Physician. 2017;20(7):E873-E881.

  6. Cahana A, Vutskits L, Muller D. Pulse radiofrequency: current clinical and biological literature available. Pain Med. 2006;7(5):411-423. DOI: 10.1111/j.1526-4637.2006.00148.x

  7. Calamassi D, Lucicesare A, Pomponi GP, et al. Listening to music tuned to 440 Hz versus 432 Hz to reduce anxiety and stress in emergency nurses during the COVID-19 pandemic: a randomized controlled pilot study. Acta Biomed. 2022;93(5):e2022247. DOI: 10.23750/abm.v93i5.13138

  8. Arnold CA, Dick M, De Jonge M, et al. The psychophysiology of music-based interventions and pain perception: a comprehensive review. Front Psychol. 2024;15:1361857. DOI: 10.3389/fpsyg.2024.1361857

  9. Ren H, Zhao C, Wang X, Shen Y, Luo F. The efficacy and safety of the application of pulsed radiofrequency, combined with low-temperature continuous radiofrequency, to the Gasserian ganglion for the treatment of primary trigeminal neuralgia: study protocol for a prospective, open-label, parallel, randomized controlled trial. Pain Physician. 2021;24(1):89–97.

     

  10. Li H, Ding Y, Zhu Y, Han Z, Yao P. Effective treatment of postherpetic neuralgia at the first branch of the trigeminal nerve by high-voltage pulsed radiofrequency: a prospective study. Front Neurol. 2021;12:746035. DOI: 10.3389/fneur.2021.746035

  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349. doi:10.1016/j.jclinepi.2007.11.008

  12. Zhao C, Ren H, Shrestha N, Meng L, Shen Y, Luo F. The efficacy of combining pulsed radiofrequency with low-temperature continuous radiofrequency for primary trigeminal neuralgia: a randomized controlled trial. J Neurosurg. 2025;143(1):100-110. DOI: 10.3171/2024.10.JNS241274

  13. Zhou G, Li H, Li Y, et al. Combination of pulsed radiofrequency with continuous radiofrequency thermocoagulation in V2/V3 primary trigeminal neuralgia: randomized controlled trial. Pain Physician. 2018;21(7):E545-E554.

  14. Li LM, et al. Efficacy of high-voltage, long-duration pulsed radiofrequency stimulation in patients with neuropathic pain. ePain. 2024. DOI: 10.3344/kjp.23324

  15. Wang Y, et al. Efficacy and safety of high-voltage vs standard-voltage PRF in neuropathic pain: meta-análisis reciente. J Pain Res. 2024. doi.org/10.2147/JPR.S439909

  16. Jorge DMF, et al. The mechanism of action between pulsed radiofrequency pertaining to pain relief: roles of cytokines, calcium, y modulación neuronal. Int J Mol Sci. 2022;23(19):11726. DOI: 10.3390/ijms231911726

[1] Machuca Vigil FJ, Jameson Rosales R, Orlando Vallejo R, Dolciami F, Perez Lozano E. Radiofrecuencia convencional y pulsada armonizada en el ganglio de Gasser para el tratamiento de la neuralgia del trigémino: resultados del protocolo Dolomedic. CC&EM [Internet]. [citado 25 de agosto de 2026];6(2):1-9. Disponible en:
https://criticalcareandemergencymedicine.com/OJS/index.php/inicio/article/view/8
PDF

Licencia

© 2025 Critical Care & Emergency Medicine by Ediciones Prado. This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) .

Licencia Creative Commons CC BY 4.0

The copyrights of the articles published in Critical Care & Emergency Medicine belong to Ediciones Prado. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Critical Care & Emergency Medicine without prior authorization for non-commercial use.

ISSN

2992-6785

eISSN: 2992-6785
DOI: 10.3989/ccem

Indexación

Patrocinadores

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