title: Use of sensory and motor action potentials to identify the position of trigeminal nerve divisions for radiofrequency thermocoagulation.
abstract: OBJECTIVE
  The objective of this study was to develop an electrophysiological method for intraoperative localization of the trigeminal nerve branches during radiofrequency thermocoagulation (RFTC).
  
  
  METHODS
  Twenty-three patients who were scheduled to undergo RFTC were included. The trigeminal nerve root was stimulated through the foramen ovale using the radiofrequency cannula. Antidromic responses were recorded from the target division through supraorbital, infraorbital, and mental foramina electrodes, and an additional electrode at the masseter muscle. Sensory and motor action responses, as well as verbal and masseter contraction responses, were recorded and correlated.
  
  
  RESULTS
  The antidromic responses were easily recorded in the target division in all 23 patients, and they were invariably correlated with the patient's verbal responses. The potentials were recorded successively from V1 to V3. The amplitude in each division before and after RFTC showed little difference in response to electrical stimulation with the same current. The motor trigeminal nerve action potentials were recorded in 10 patients; 7 of these patients had postoperative masseter muscle weakness, while the remaining 3 had normal masseter muscle function. Potentials with low amplitudes were usually obtained from neighboring divisions, but no unexpected denervation of any branches was observed. All the patients experienced immediate pain relief after the procedure.
  
  
  CONCLUSIONS
  This technique is sensitive and easy to apply. The sensory and motor potentials matched the verbal responses and the complications. Although it cannot completely substitute for the patient's verbal response, this approach is helpful in uncooperative patients, and it predicts and reduces the incidence of masseter muscle weakness. The use of these complementary techniques could increase the chances of treatment success.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Lin
authors.forename: Xuguang
authors.initials: X
authors.lastname: Lu
authors.forename: Xinli
authors.initials: X
authors.lastname: Zhai
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Cai
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000379:methods*; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008340:Mandibular Nerve / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D008442:Maxillary Nerve / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009882:Ophthalmic Nerve / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D014276:Trigeminal Nerve / Q000033:anatomy & histology* / Q000503:physiopathology / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000503:physiopathology / Q000601:surgery*
keywords: EMG = electromyography; MTAP = motor trigeminal action potential; RFTC = radiofrequency thermocoagulation; STAP = sensory trigeminal action potential; electromyography; functional neurosurgery; pain; sensory response; trigeminal neuralgia