Percutaneous trigeminal rhizotomy

Percutaneous trigeminal rhizotomy

Anesthesia type	General
Airway	LMA
Lines and access	PIV
Monitors	Standard
Primary anesthetic considerations
Preoperative	Trigeminal pain may limit preoxygenation
Intraoperative
Postoperative
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A percutaneous trigeminal rhizotomy is a neurosurgical procedure performed to treat trigeminal neuralgia.

Overview

Indications

• Medication-resistant trigeminal neuralgia

Surgical procedure

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.

Preoperative management

Patient evaluation

System	Considerations
Airway	Patient may not tolerate face mask placement during preoxygenation
Neurologic	Inquire about pain triggers for trigeminal neuralgia

Operating room setup

• Procedure can be performed on transport bed

Patient preparation and premedication

• Patient should take home neuropathic agents

Intraoperative management

Induction and airway management

• LMA is sufficient for surgical purposes

Positioning

• Supine
• Can be performed on transport gurney

Maintenance and surgical considerations

• If using glycerin ablation, head of bed will need to be maintained at 60° after injection

Emergence

• Blood may be present in oropharynx due to tissue disruption

Postoperative management

Disposition

• PACU
• Typically outpatient

Pain management

• Continue home neuropathic agents

Potential complications

• Other cranial nerve injury

Procedure variants

	Glycerin ablation	Radiofrequency ablation	Endoscopic ablation
Unique considerations			Allows direct visualization of anatomic structures
Indications		Patients who don't achieve full relief from glycerin ablation
Position	Maintain head of bed at 60° after injection
Postoperative disposition
Potential complications