Why is this surgery done?
This procedure is done to treat trigeminal neuralgia, which is one cause of severe facial pain. As with other surgeries for trigeminal neuralgia, the best response is seen in patients with:
- Sharp, electric jolts of pain that last just a few seconds
- No pain or numbness between jolts
- Pain only on one side of the face, between the hairline and the chin or in the teeth
This procedure is done only for patients who have tried medication for pain without success. It is less likely to work in patients with atypical pain or pain that is less likely to be trigeminal neuralgia. This includes constant pain, dull or aching pain, pain outside the face (such as behind the ear or down the neck), pain on both sides of the face or pain with numbness, as well. This procedure could even make such atypical pain worse.
How is percutaneous rhizotomy done?
After the patient is asleep, a tiny cut is made one inch to the side of the corner of the mouth. A needle is then passed through the wall of the check to the bottom of the skull. Using x-ray or CT scans, the needle is guided through a small opening in the skull into an area called Meckel’s cave, where the trigeminal nerve lives.
At this point a procedure is done to damage the nerve in a controlled fashion. The procedure may:
- Compress the nerve with a balloon for a short period of time
- Burn the nerve with an electrode at high temperature
- Burn the nerve with a chemical called glycerol
The most common procedure is the first: a balloon compression rhizotomy. This procedure allows the patient to remain fully asleep, and only takes 5 – 10 minutes in most instances. The needle is then removed, and the patient returns home after waking up from anesthesia in a few hours.
What are my risks? What are common complications?
The most common risk is that the pain may not fully resolve or may return in the near or distant future. The majority of patients will obtain complete relief of their face pain and be able to stop their face pain medication. Some patients may have their pain go away but will still need to take medication, and some patients only have a partial decrease in facial pain.
Most patients will experience some numbness on one side of the face afterward. It is often mild and improves with time, but some patients may experience significant numbness on one half of their face.
Stiffness in the jaw on the treated side is normal and usually improves over a few weeks. Some swelling in the cheek may also occur and can be treated with warm and cold compresses and pain medication.
Injuries to important arteries in the head and brain from the placement of the needle are extremely uncommon but could require immediate treatment in the hospital.
What do I need to know before surgery?
You should be off of any blood thinning medication for this surgery. Smoking and alcohol use should be stopped before surgery. You may need appointments for medical clearance or to get special imaging studies before your surgery.
General discharge instructions
This is an outpatient procedure and patients go home a few hours after it is completed. The tiny hole in the skin is covered with a small bandage that can be removed 1 – 2 days after surgery. After that, the patient can wash the area. Your doctor will tell you when you can resume blood thinning medication after surgery.
What should I expect while recovering?
Most patients will have prompt improvement in their face pain, but some pain improvement may not occur right away. If there is still pain, the patient should stay on their face pain medication until it fully goes away. Once the pain is gone after the procedure, the patient should taper off their face pain medication(s) one at a time and not stop them suddenly. Most patients can resume normal activity a few days after the procedure.