Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract
CPT4 code
Name of the Procedure:
Creation of Lesion by Stereotactic Method, Percutaneous, by Neurolytic Agent; Trigeminal Medullary Tract
Common Names: Trigeminal Medullary Tract Lesioning, Stereotactic Neurolysis Trigeminal Medullary Tract
Summary
This procedure involves creating a targeted lesion, or small area of damage, in the trigeminal medullary tract using a precision-guided technique. The lesion is created using a neurolytic agent such as alcohol, thermal energy, electrical currents, or radiofrequency, all of which are delivered percutaneously (through the skin).
Purpose
This procedure is designed to alleviate chronic facial pain, particularly trigeminal neuralgia—a condition characterized by severe, recurring pain in the face. The goal is to disrupt pain signals traveling along the trigeminal nerve pathway to provide long-term pain relief.
Indications
- Persistent, debilitating facial pain consistent with trigeminal neuralgia
- Failure of conservative treatments such as medication
- Patients who cannot tolerate or have contraindications to other surgical options
Preparation
- Patients may be instructed to fast for several hours before the procedure.
- Adjustments to medication regimens, particularly blood thinners, may be necessary.
- Pre-procedure imaging (such as MRI or CT scans) may be conducted to pinpoint the exact target area.
Procedure Description
- The patient is placed under local anesthesia and possibly light sedation.
- Using imaging guidance, such as fluoroscopy or CT, the physician precisely navigates a needle to the trigeminal medullary tract.
- Once in place, the neurolytic agent (e.g., alcohol for chemical neurolysis, or a device for thermal, electrical, or radiofrequency neurolysis) is delivered through the needle to create the lesion.
- The needle is then carefully withdrawn, and the puncture site is dressed.
Duration
The procedure typically takes about 1 to 2 hours from start to finish.
Setting
This procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped with advanced imaging technology.
Personnel
- Neurosurgeon or interventional radiologist
- Radiology technician
- Anesthesiologist or nurse anesthetist
- Nursing staff
Risks and Complications
- Pain or discomfort at the needle insertion site
- Infection
- Bleeding
- Numbness or altered sensation in the face
- Unintended damage to surrounding neural structures
- Rarely, cerebrospinal fluid leak or vascular injury
Benefits
- Effective, long-term pain relief for patients suffering from trigeminal neuralgia
- Minimally invasive with a relatively quick recovery period
- Reduced need for pain medication
Recovery
- Patients can typically go home the same day.
- Mild pain and swelling at the injection site may be managed with over-the-counter pain relievers.
- Most patients can return to normal activities within a few days, barring any specific restrictions advised by the physician.
- Follow-up appointments are scheduled to monitor progress and manage any complications.
Alternatives
- Pharmacological treatments (e.g., anticonvulsants, analgesics)
- Other surgical interventions (e.g., microvascular decompression, gamma knife radiosurgery)
- Non-surgical options (e.g., physical therapy, acupuncture)
- Compared to these alternatives, the described procedure often offers quicker relief with fewer systemic side effects.
Patient Experience
During the procedure, patients may feel some pressure or discomfort as the needle is positioned, but pain is typically minimal due to anesthesia. Post-procedure, patients might experience numbness or a change in sensation in the treated area, which can last for a few days to weeks. Pain management and comfort measures, including prescribed medications, are provided to ensure a smooth recovery.