TRIGEMINAL NEURALGIA: SURGICAL TREATMENT
Trigeminal neuralgia is easy to diagnose among facial pains:
The clinical features of tic pain:
PPT Slide
Trigeminal nerve anatomy
Tic pain is caused by compression or irritation of the trigeminal nerve:
Historical footnote…..
A rare cause of tic pain is compression by a benign tumor adjacent to the nerve
Treatment of Tic Pain:
A brief intravenous general anesthesia is administered
Once anesthetized, the face is numbed and a needle is passed into the nerve in the skull base
The head is positioned within fluoroscope for imaging
Cerebral spinal fluid is released from the space about the ganglion, confirming the location
Dye is injected into the space around the nerve ganglion and imaged by fluoroscopy
Results : Glycerol Injection
Historical footnote. . . .
A radiofrequency electrode is inserted into the ganglion
The tip of the electrode contains a thermocouple for temperature
Results : Radiofrequency Lesion
A balloon catheter is inserted into the ganglion and inflated to compress the nerve within the skull base
Controlled compression damages the trigeminal nerve resulting in pain relief
Needle in position for compression
Balloon inflated with dye
Results : Balloon Compression
Microvascular decompression requires an open operation . . . …overnight stay in an intensive care unit and a few days’ stay in the hospital
Results : Microvascular Decompression in 1336 Pts.
Complications : Microvascular Decompression in 1336 Pts.
Email: kott@cts.com
Home Page: sd-neurosurgeon.com
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