Bipolar versus Monopolar Thermal Radiofrequency of Gasserian Ganglion in Management of Trigeminal Neuralgia

Background: Trigeminal neuralgia is a severely debilitating neuropathic pain disorder, and radiofrequency ablation (RFA) of the trigeminal ganglion is an established intervention for medically refractory cases. This study aimed to evaluate whether bipolar thermal radiofrequency ablation of the Gasserian ganglion can enhance clinical outcomes, reduce pain recurrence, and minimize procedure-related complications compared with the conventional monopolar thermal radiofrequency technique. Methods: This prospective randomized comparative study included 42 adult patients with refractory idiopathic TN , patients were randomly assigned to undergo either bipolar or monopolar RFA (21each). Baseline characteristics, intraoperative parameters, procedural duration, pain intensity measured by the Visual Analogue Scale, complications, and patient satisfaction (Likert scale) were evaluated over a six-month follow-up period. Results: Both techniques significantly reduced pain over time; however, the bipolar group achieved faster and more sustained pain relief, with significantly lower VAS scores starting from the second week post-procedure and continuing through the 1st, 3rd, and 6th months (p