Procedure Guides

Radiofrequency Treatment of the Lumbar Medial Branch

by Charles A. Gauci, MD, FRCA, FIPP, FFPMRCA

This guide details Dr. Charles Gauci’s method for percutaneous RF denervation of the lumbo-sacral facets and sacroiliac joints, one of the most fundamental and commonly performed RF procedure in pain medicine.  Pain from these joints is estimated to account for 15% of chronic lower back pain.  The guide covers epidemiology, diagnosis, pre-operative routine, facilities and surgical equipment, operative steps including cannulae placement and RF generator operation, and post-operative care.

Dr. Gauci has been actively involved in pain management since 1979 and is a world-renowned educator, clinician, and leader in interventional pain medicine.  He is the author of “Manual of RF Techniques”, a popular, practical manual of RF procedures in chronic pain medicine.  He practices at Whipps Cross University Hospital in London, and at Queen’s Hospital in Essex, UK.

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Percutaneous Stereotactic Radiofrequency Treatment of Trigeminal Neuralgia

by John M. Tew, Jr, MD, FACS, and Andrew Grande, MD

In this guide, Drs. Tew and Grande detail the RF technique they have personally used to treat over 3000 patients with trigeminal neuralgia.  This percutaneous, outpatient method provides “a safe and proven method of achieving long-term pain relief from trigeminal neuralgia.” The published recurrence rate with this technique is “25% over 15 years, which is better than other percutaneous procedures and comparable to microvascular decompression,” an open neurosurgical procedure. The guide covers diagnosis, pre-operative routine, facilities and surgical equpment, operative steps including cannulae placement and RF generator operation, post-operative care, and a literature review on outcomes. 

Dr. Tew is a pioneer in RF treatment of trigeminal neuralgia, having developed the curved TEW trigeminal electrode with Dr. Eric Cosman, Sr, PhD in the late 1970’s. Dr. Tew is a neurosurgeon at the Mayfield Clinic in Cincinnati, Ohio, specializing in brain tumors, spinal cord tumors, acoustic neuromas, pituitary tumors, shingles, trigeminal neuralgia, glossopharyngeal neuralgia, percutaneous stereotactic rhizotomy (PSR), microvascular decompression (MVD), hemifacial spasm, and Chiari malformations. Dr. Andrew Grande is a graduate of the Mayfield Clinic’s Neurosurgerical residency program and is now an assistant professor of neurosurgery at the University of Minnesota. 

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Dorsal Root Entry Zone (DREZ) Radiofrequency Thermocoagulation: Cervical and Nucleus Caudalis

by Nestor D. Tomycz MD, Amr O. El-Naggar MD, Stephen E. Sandwell MD, and John J. Moossy MD

Despite the rise of neuromodulation surgeries for pain, DREZ thermocoagulation remains the best evidence-based treatment for deafferentation pain. Cervical DREZ radiofrequency thermocoagulation remains a safe and highly effective operation for patients suffering from chronic pain from cervical nerve root avulsions and phantom limb pain. Nucleus caudalis DREZ has proven effective for medically-intractable facial pain syndromes including post-herpetic neuralgia, brainstem infarct-related facial pain, anesthesia dolorosa, facial pain due to multiple sclerosis, and cancer-related facial pain. Detailed followup studies from Dr. Blaine Nashold’s practice suggest the as many as 90% of patients with brachial plexus avulsion may be pain free immediately after surgery and more than 70% continue to have complete or good palliation years later.

Drs. Amr El-Naggar and John Moossy trained under Dr. Blaine Nashold at Duke University during the formative years of the DREZ operation. Dr. El-Naggar designed the first electrode for nucleus caudalis DREZ lesioning with Dr. Nashold and Prof. Eric Cosman Sr, PhD.  Drs. Nestor Tomycz and John Moossy practice at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Dr. El-Naggar practices at Lake Cumberland Neurosurgical Clinic, Somerset, Kentucky. Dr. Stephen Sandwell practices at University of Rochester, Rochester, New York.

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Other Guides

Cosman Medical also sells high-quality guides and books that are printed by other publishers.

Manual of RF Techniques (3rd Edition, 2011)

by Charles A. Gauci, MD, FRCA, FIPP, FFPMRCA

Now in its third edition, Dr. Gauci’s Manual is a “how to do it” radiofrequency handbook that concentrates on the essentials of widely used RF pain management procedures, including facet denervation, PRF of the DRG, sympathetic RF, facial RF, RF cordotomy, and peripheral nerve RF. The text is reduced to a bare minimum and is accompanied by a series of clear illustrations. Spring-bound, laminated, and supplied with a waterproof pen, the manual can be taken into the operating theater when performing procedures. This edition contains guest chapters from several big names in interventional pain management: Professor Alex Cahana, Professor Phillip Finch, Professor Eric Cosman Sr., Dr. Eric Cosman Jr., Professor Miles Day, and Dr. Olaf Rohof.

Active in pain management since 1979, Dr.Gauci is Lead Consultant in pain management at Whipps Cross University Hospital, London; an Honorary Consultant in pain management at Guy’s & St. Thomas’ Hospital, London, UK; and a Visiting Consultant in pain management to the Ministry of Health in Malta. He is also Honorary Secretary of the World Institute of Pain (WIP), a Trustee of the WIP Foundation, and an examiner for the FIPP Diploma.

The Manual of RF Techniques is published by CoMedical BV (Ridderkerk, Netherlands).

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