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
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.
related to the operative site:
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.
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.
Blood clots in the legs, heart attacks, reaction to the
to keep the needle entry site dry and clean. Notify
your surgeon of any drainage or temperatures greater than
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.
upon discharge, contact our office and set up an appointment
for a follow up visit.
it easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended.
jogging or running.
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
Sexual activities are permitted.
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.
you have any questions, call our office, and for after
hours emergencies, call the after hours number.
your medications prescribed on discharge, as directed.