Trigeminal ganglion/rootlets ablation for pain

Percutaneous radiofrequency trigeminal gangliolysis is one ablative technique which can be used in the management of idiopathic trigeminal neuralgia. Advantages of this technique include a potentially selective lesion, an immediate benefit conferred to the patient, the ability to control the degree of hypesthesia, and the possibility of performing the procedure multiple times with pain recurrence. More than 95% of patients will experience immediate pain relief following percutaneous radiofrequency ablation, with more than 50% of patients maintaining pain relief 5 years following the procedure. The use of submental vertex fluoroscopy can provide direct visualization of the foramen ovale, and allow safe cannulation of the foramen through a sequential palpitation technique along the infratemporal fossa. Care must be exercised when treating V1 trigeminal neuralgia as corneal anesthesia can occur increasing the risk of corneal keratitis. As with all ablative techniques for trigeminal neuralgia, patients must be counseled that a degree of numbness is the desired outcome of this procedure, not a complication.