https://wikianesthesia.org/w/index.php?action=history&feed=atom&title=Percutaneous_trigeminal_rhizotomyPercutaneous trigeminal rhizotomy - Revision history2026-04-27T21:15:08ZRevision history for this page on the wikiMediaWiki 1.37.1https://wikianesthesia.org/w/index.php?title=Percutaneous_trigeminal_rhizotomy&diff=13876&oldid=prevChris.Rishel: Started article2022-08-30T17:39:57Z<p>Started article</p>
<p><b>New page</b></p><div>{{Infobox surgical procedure<br />
| anesthesia_type = General<br />
| airway = LMA<br />
| lines_access = PIV<br />
| monitors = Standard<br />
| considerations_preoperative = Trigeminal pain may limit preoxygenation<br />
| considerations_intraoperative = <br />
| considerations_postoperative = <br />
}}A '''percutaneous trigeminal rhizotomy''' is a neurosurgical procedure performed to treat [[Trigeminal neuralgia|trigeminal neuralgia]].<br />
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==Overview==<br />
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===Indications<!-- List and/or describe the indications for this surgical procedure. -->===<br />
<br />
* Medication-resistant trigeminal neuralgia<br />
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===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->===<br />
The procedure is performed percutaneously through a touhy needle inserted in the cheek. After identification of the target site under fluoroscopy, the trigeminal nerve is ablated. This can be performed using glycerin, radiofrequency, or surgically under endoscopic visualization.<br />
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==Preoperative management==<br />
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===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===<br />
{| class="wikitable"<br />
|+<br />
!System<br />
!Considerations<br />
|-<br />
|Airway<br />
|Patient may not tolerate face mask placement during preoxygenation<br />
|-<br />
|Neurologic<br />
|Inquire about pain triggers for trigeminal neuralgia<br />
|}<br />
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===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===<br />
<br />
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===<br />
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* Procedure can be performed on transport bed<br />
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===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===<br />
<br />
* Patient should take home neuropathic agents <br />
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==Intraoperative management==<br />
<br />
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===<br />
<br />
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===<br />
<br />
* LMA is sufficient for surgical purposes<br />
<br />
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===<br />
<br />
* Supine<br />
* Can be performed on transport gurney<br />
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===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===<br />
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* If using glycerin ablation, head of bed will need to be maintained at 60° after injection<br />
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===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===<br />
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* Blood may be present in oropharynx due to tissue disruption<br />
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==Postoperative management==<br />
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===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===<br />
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* PACU<br />
* Typically outpatient<br />
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===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===<br />
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* Continue home neuropathic agents<br />
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===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===<br />
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* Other cranial nerve injury<br />
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==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==<br />
<br />
{| class="wikitable wikitable-horizontal-scroll"<br />
|+<br />
!<br />
!Glycerin ablation<br />
!Radiofrequency ablation<br />
!Endoscopic ablation<br />
|-<br />
|Unique considerations<br />
|<br />
|<br />
|Allows direct visualization of anatomic structures<br />
|-<br />
|Indications<br />
|<br />
|Patients who don't achieve full relief from glycerin ablation<br />
|<br />
|-<br />
|Position<br />
|Maintain head of bed at 60° after injection<br />
|<br />
|<br />
|-<br />
|Postoperative disposition<br />
|<br />
|<br />
|<br />
|-<br />
|Potential complications<br />
|<br />
|<br />
|<br />
|}<br />
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==References==<br />
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[[Category:Surgical procedures]]<br />
[[Category:Neurosurgery]]</div>Chris.Rishel