Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy rhinorrhea

Report of three cases and a cadaver study

Hasan Caglar Ugur, Ali Savas, Alaittin Elhan, Yücel Kanpolat, Farhad Limonadi, Kim Burchiel, L. Dade Lunsford, Björn A. Meyerson, Oren Sagher

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia: vascular decompression of the trigeminal root in the brainstem, percutaneous trigeminal ganglion procedures, and external beam radiosurgery. Percutaneous radiofrequency electrodes target the trigeminal fibers in the gasserian ganglion through the foramen ovale. Several complications of radiofrequency trigeminal rhizotomy (RF-TR) have been described, including puncture of the carotid artery, the cavernous sinus, and the cranial nerves. This study presents a very rare complication of percutaneous RF-TR, rhinorrhea, and attempts to define its mechanism. CLINICAL PRESENTATION: Of 2375 patients with idiopathic trigeminal neuralgia who underwent 2958 percutaneous RF-TR procedures, 3 developed subsequent rhinorrhea, which resolved spontaneously in 2 to 3 days. TECHNIQUE: Two formalin-fixed cadavers were dissected to demonstrate the relationship between the foramen ovale and the tuba auditiva and the mechanism of rhinorrhea. CONCLUSION: This article presents a very rare complication of RF-TR. Rhinorrhea and/or cerebrospinal fluid fistulae in the nasopharyngeal cavity are benign complications of RF-TR that result from puncturing both the membranous portion of the tuba auditiva (eustachian tube) and Meckel's cave with the rhizotomy needle.

Original languageEnglish (US)
Pages (from-to)1522-1526
Number of pages5
JournalNeurosurgery
Volume54
Issue number6
StatePublished - Jun 2004
Externally publishedYes

Fingerprint

Rhizotomy
Cadaver
Foramen Ovale
Trigeminal Ganglion
Trigeminal Neuralgia
Cerebrospinal Fluid Rhinorrhea
Neurosurgical Procedures
Eustachian Tube
Cavernous Sinus
Radiosurgery
Cranial Nerves
Decompression
Carotid Arteries
Punctures
Formaldehyde
Brain Stem
Fistula
Needles
Blood Vessels
Electrodes

Keywords

  • Anatomy
  • Complication
  • Radiofrequency rhizotomy
  • Rhinorrhea
  • Trigeminal neuralgia

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Ugur, H. C., Savas, A., Elhan, A., Kanpolat, Y., Limonadi, F., Burchiel, K., ... Sagher, O. (2004). Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy rhinorrhea: Report of three cases and a cadaver study. Neurosurgery, 54(6), 1522-1526.

Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy rhinorrhea : Report of three cases and a cadaver study. / Ugur, Hasan Caglar; Savas, Ali; Elhan, Alaittin; Kanpolat, Yücel; Limonadi, Farhad; Burchiel, Kim; Lunsford, L. Dade; Meyerson, Björn A.; Sagher, Oren.

In: Neurosurgery, Vol. 54, No. 6, 06.2004, p. 1522-1526.

Research output: Contribution to journalArticle

Ugur, HC, Savas, A, Elhan, A, Kanpolat, Y, Limonadi, F, Burchiel, K, Lunsford, LD, Meyerson, BA & Sagher, O 2004, 'Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy rhinorrhea: Report of three cases and a cadaver study', Neurosurgery, vol. 54, no. 6, pp. 1522-1526.
Ugur, Hasan Caglar ; Savas, Ali ; Elhan, Alaittin ; Kanpolat, Yücel ; Limonadi, Farhad ; Burchiel, Kim ; Lunsford, L. Dade ; Meyerson, Björn A. ; Sagher, Oren. / Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy rhinorrhea : Report of three cases and a cadaver study. In: Neurosurgery. 2004 ; Vol. 54, No. 6. pp. 1522-1526.
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abstract = "OBJECTIVE AND IMPORTANCE: Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia: vascular decompression of the trigeminal root in the brainstem, percutaneous trigeminal ganglion procedures, and external beam radiosurgery. Percutaneous radiofrequency electrodes target the trigeminal fibers in the gasserian ganglion through the foramen ovale. Several complications of radiofrequency trigeminal rhizotomy (RF-TR) have been described, including puncture of the carotid artery, the cavernous sinus, and the cranial nerves. This study presents a very rare complication of percutaneous RF-TR, rhinorrhea, and attempts to define its mechanism. CLINICAL PRESENTATION: Of 2375 patients with idiopathic trigeminal neuralgia who underwent 2958 percutaneous RF-TR procedures, 3 developed subsequent rhinorrhea, which resolved spontaneously in 2 to 3 days. TECHNIQUE: Two formalin-fixed cadavers were dissected to demonstrate the relationship between the foramen ovale and the tuba auditiva and the mechanism of rhinorrhea. CONCLUSION: This article presents a very rare complication of RF-TR. Rhinorrhea and/or cerebrospinal fluid fistulae in the nasopharyngeal cavity are benign complications of RF-TR that result from puncturing both the membranous portion of the tuba auditiva (eustachian tube) and Meckel's cave with the rhizotomy needle.",
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AB - OBJECTIVE AND IMPORTANCE: Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia: vascular decompression of the trigeminal root in the brainstem, percutaneous trigeminal ganglion procedures, and external beam radiosurgery. Percutaneous radiofrequency electrodes target the trigeminal fibers in the gasserian ganglion through the foramen ovale. Several complications of radiofrequency trigeminal rhizotomy (RF-TR) have been described, including puncture of the carotid artery, the cavernous sinus, and the cranial nerves. This study presents a very rare complication of percutaneous RF-TR, rhinorrhea, and attempts to define its mechanism. CLINICAL PRESENTATION: Of 2375 patients with idiopathic trigeminal neuralgia who underwent 2958 percutaneous RF-TR procedures, 3 developed subsequent rhinorrhea, which resolved spontaneously in 2 to 3 days. TECHNIQUE: Two formalin-fixed cadavers were dissected to demonstrate the relationship between the foramen ovale and the tuba auditiva and the mechanism of rhinorrhea. CONCLUSION: This article presents a very rare complication of RF-TR. Rhinorrhea and/or cerebrospinal fluid fistulae in the nasopharyngeal cavity are benign complications of RF-TR that result from puncturing both the membranous portion of the tuba auditiva (eustachian tube) and Meckel's cave with the rhizotomy needle.

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