Percutaneous Procedures

Percutaneous procedures are destructive procedures where a needle is inserted through the cheek and up a hole into the skull base to the trigeminal ganglion.  Once the needle is in place, a surgeon can either crush the nerve (balloon compression), bathe the nerve the glycerol (glycerol rhizotomy), or heat the nerve (radiofrequency rhizotomy) to disrupt the nerve’s transmission of pain signals.

These procedures are attractive because typically they are less risky and are done as outpatient procedures where the patient comes into the hospital, has the procedure done, and goes home the same day, usually pain-free.  If and when the pain returns, these procedures can be repeated.

Disadvantages of these procedures include if there is a vascular compression then the problem is not treated, the length of pain relief varies by procedure, patients usually end up trading pain for facial numbness from having this type of procedure, some other risks, and repeating these  procedures can increase the amount of nerve damage which can produce more numbness and possibly a painful numbness called anesthesia dolorosa.

Percutaneous treatment for trigeminal neuralgia: experience with 609 procedures
http://www.egms.de/de/meetings/dgnc2005/05dgnc0303.shtml

Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia.
http://www.theneurologist.org/pt/re/neurologist/abstract.00006123-200404000-00041.htm

Organizations

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