Trigeminal neuralgia treated by differential percutaneous radiofrequency coagulation of the Gasserian ganglion

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✓ The authors describe surgical and anesthetic techniques for the treatment of trigeminal neuralgia by radiofrequency coagulation. Using radiographic landmarks derived from a stereotaxic study of 54 cadaver skulls, they delineate lateral and anteroposterior guidelines which aid in the percutaneous penetration of the foramen ovale. Controlled lesions can be made selectively in any division of the trigeminal nerve. The procedure has been effective in abolishing pain usually with preservation of touch sensation in the face. The percutaneous operation has the added advantage of a short hospitalization, usually 2 days. Of the 65 patients treated, only one still has the pain of trigeminal neuralgia. In six instances the procedure had to be repeated because insufficient sensory deficit was produced by the initial lesion. Three patients have developed anesthesia dolorosa; however, none has developed facial paralysis.

Article Information

Address reprint requests to: G. R. Nugent, M.D., Division of Neurosurgery, West Virginia University Medical Center, Morgantown, West Virginia 26506.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Lateral view of cadaver skull in stereotaxic frame showing target site at junction of shadows produced by the clivus and petrous ridge. Right: Line drawing of lateral projection showing target site at vertex of lines produced by the clivus and petrous ridge.

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    Left: Cadaver skull showing lead oval at site of ganglion in line with internal auditory canal and at the medial point of “dip” in superior aspect of petrous ridge. Right: Line drawing of this projection defining ganglion in relation to lateral wall of internal auditory meatus.

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    Left: Lateral x-ray film of patient showing relationship of electrode tip to angle created by clivus and petrous ridge. Right: Anteroposterior projection showing electrode tip at medial aspect of “dip” in petrous ridge and at midpoint of internal auditory canal.

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    Drawing showing how depth of penetration determines location of electrode in retrogasserian rootlets.

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