OneRF radiofrequency ablation system for the minimally invasive treatment of trigeminal neuralgia: initial clinical experience

BACKGROUND: Percutaneous radiofrequency ablation is an established treatment for medically refractory trigeminal neuralgia (TN). Conventional systems use a single active tip and often require repeated repositioning. A multi-contact radiofrequency platform may permit contact-level interrogation and lesioning along a single fixed trajectory. METHODS: We performed a retrospective review of patients with medically refractory TN treated with a multi-contact thin-film radiofrequency probe. Demographics, operative details, Barrow Neurological Institute (BNI) pain scores, medication use, and complications were reviewed. Contact-level localization was performed intraoperatively, including low-temperature thermal interrogation, followed by definitive lesioning. RESULTS: Fifteen patients (mean age 66.5 years; 12 women) underwent treatment. Most had classical or idiopathic TN, purely paroxysmal involving the V2-V3 distribution. Contact-level mapping was successfully achieved in all cases with definitive lesioning along a fixed trajectory. At mean follow-up of 6.0 months, all patients had a good outcome (BNI I-IIIB), and most had reduced or discontinued pain medications. No off-target lesioning was observed. CONCLUSIONS: This early clinical series suggests that a multi-contact radiofrequency platform can facilitate contact-level mapping and lesioning of trigeminal distributions along a single trajectory without repeated probe repositioning. Initial pain outcomes were favorable, although larger cohorts and longer follow-up are needed to define durability and comparative effectiveness.