Trigeminal tractotomy-nucleotomy

Trigeminal tractotomy is an ablative procedure used for control of facial pain. This therapy can be effective for trigeminal neuropathic pain, poststroke pain, and postherpetic neuralgia. The target of ablation is the lateral descending trigeminal tract and the nucleus caudalis of the spinal trigeminal tract. We perform the procedure using radiofrequency ablation via a percutaneous approach that approaches the target between the occiput and C1. The procedure is done under CT guidance, with the patient position prone and having undergone a recent myelogram. The procedure is done with the patient under general anesthesia, and motor and sensory test stimulation is performed. Then, two lesions are created at 80°C for 60 s each. The most common adverse effect is transient ipsilateral ataxia. Pain relief is often durable for at least 6-12 months.