Percutaneous Procedures for Trigeminal Neuralgia

Abstract

Microvascular decompression is the gold standard for the treatment of trigeminal neuralgia (TN). However, percutaneous techniques still play a role in treating patients with TN and offer several important advantages and efficiency in obtaining immediate pain relief, which is also durable in a less invasive and safe manner. Patients' preference for a less invasive method can influence the procedure they will undergo. Neurovascular conflict is not always a prerequisite for patients with TN. In addition, recurrence and failure of the previous procedure can influence the decision to follow the treatment. Therefore, indications for percutaneous procedures for TN persist when patients experience idiopathic and episodic sharp shooting pain. In this review, we provide an overview of percutaneous procedures for TN and its outcome and complication.

Keywords: Glycerol rhizotomy; Percutaneous balloon compression; Radiofrequency thermocoagulation; Trigeminal neuralgia.

Fig. 1.

Patient preparation and Hartel’s method landmarks. Hartel’s anatomic landmarks were drawn on the ipsilateral face of the patient, inferior to the medial pupil, 3 cm anterior to the external auditory meatus, and 2.5 cm lateral to the lips.

Fig. 2.

Catheter insertion through the foramen ovale (left : anteroposterior view; right : lateral view).

Fig. 3.

A : The patient is positioned on carbon plate table affixed with plaster to achieve intraoperative computed tomography (CT) scan. B : Based on intraoperative CT images, the entry and target of the foramen ovale are defined. A Tuohy needle is introduced under the guidance of a neuronavigation system. C : The actual Tuohy needle tip is lateral to the planned path (green dash line). D : In some cases, the traditional path by the Hartel method is not accepted because of bony collisions (yellow arrow).