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Rhizotomy

Procedure description

Trigeminal neuralgia, which is spasmodic, lancinating pain traveling to one side of the face, is sometimes treated with a percutaneous trigeminal rhizotomy.  This is a procedure which "deadens" the trigeminal (Gasserian) ganglion, which is where the sensory fibers from the various portions of the face come together.  The rhizotomy, (controlled lesion to the nerve) may be done with radiofrequency (heat), glycerol, or mechanical trauma (with a small balloon catheter).  The procedure requires the patient to be awake, and able to cooperate.  X ray guidance is used for placement of the needle into the cheek, and aiming it up to the skull base to enter into one of the openings (foramen ovale) and then passing into the gasserian ganglion.

Procedure Risks

There are potential risks to the procedure.    Risks  can be broken down into two categories, 1) those related to the operative site, and 2) those related to the risks of anesthesia. 

Risks related to the operative site: 

Surgical Exposure: The patient is placed in a supine position (on their back). Under x-ray guidance, a needle is inserted into the cheek, and aimed toward the skull base, to enter into the ganglion of the trigeminal nerve. The needle could hit the carotid artery, causing bleeding or blood  vessel injury. This could potentially result in stroke. It may injure other nerves at the base of the skull.  It could pass into the brain, and cause brain damage. There could be bleeding into or around the brain.

General Risks: These include  general difficulties, such as bleeding, infection, stroke, paralysis, coma and death. There is also the possibility that the surgery may not relieve the symptoms for which the procedure was performed. The problem for which the surgery was performed may recur, requiring additional surgery in the future.  In addition, a painful condition of burning and numbness, known as anesthesia dolorosa may occur. Although every attempt is made to protect all areas of the body from pressure on nerves, skin and bones, injuries to these areas can occur, particularly with prolonged cases. Hypertension (temporary high blood pressure) or bradycardia (low pulse) may occur as a result of the procedure.

Risks of Anesthesia:
Blood clots in the legs, heart attacks, reaction to the anesthetic. 

Post-operative care:

Remember to keep the needle entry site dry and clean.  Notify your surgeon of any drainage or temperatures greater than 101 Fahrenheit.

The following is a list of suggestions that should help speed your recovery and give you every possible chance for the best results from your surgery.

  1. Immediately upon discharge, contact our office and set up an appointment for a follow up visit.
  2. Take it easy until seen by the physician.  This does not mean bed rest, but athletic activities during this period are definitely not recommended. 
  3. No jogging or running.
  4. You may shower after you go home unless otherwise instructed.  Cover the needle insertion site  with plastic wrap before the shower and remove it afterward.  Change dressing immediately. 
  5. Sexual activities are permitted.
  6. If you notice swelling, redness or opening of the needle insertion site, or if there is any clear fluid draining from it, please contact your surgeon immediately!  If you develop a fever, stiff neck or chills, contact the office immediately.  Take your temperature at 4:00 PM daily until the clips are removed.  Call if greater than 101 degrees Fahrenheit.
  7. If you have any questions, call our office, and for after hours emergencies, call the after hours number.
  8. Take your medications prescribed on discharge, as directed.

 

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