64605 Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale

Name of the Procedure:

Destruction by Neurolytic Agent, Trigeminal Nerve; Second and Third Division Branches at Foramen Ovale
Common Name(s): Neurolytic Trigeminal Nerve Block, Trigeminal Nerve Ablation

Summary

This procedure involves using a neurolytic agent to intentionally damage certain branches of the trigeminal nerve, specifically the second and third divisions, at a point called the foramen ovale. This is done to alleviate chronic facial pain by disrupting pain signals.

Purpose

The procedure is designed to provide relief from severe, chronic facial pain typically associated with conditions like trigeminal neuralgia. The goal is to reduce or eliminate pain by impairing the nerve's ability to transmit pain signals.

Indications

• Severe, debilitating facial pain unresponsive to other treatments
• Diagnosed trigeminal neuralgia affecting the second and third divisions of the trigeminal nerve
• Patients who have not found relief from medications or less invasive procedures

Preparation

• Patients may need to fast for several hours before the procedure.
• Medications might need adjustment; blood thinners may need to be paused.
• Pre-procedure assessments may include imaging studies like MRI or CT scans, and neurological examinations.

Procedure Description

1. The patient typically lies in a supine position.
2. Local anesthesia is administered at the site to prevent pain during the procedure; sometimes, conscious sedation is used.
3. A needle is guided to the foramen ovale using fluoroscopic or CT imaging for accurate placement.
4. Once the needle is in position, a neurolytic agent (such as alcohol, phenol, or glycerol) is injected to damage the nerve branches.
5. The needle is then carefully removed, and the site is observed for a short period.

Duration

The procedure usually takes between 30 to 60 minutes.

Setting

The procedure is typically performed in an outpatient clinic, hospital, or surgical center equipped for interventional pain management.

Personnel

• Interventional pain management specialist or neurosurgeon
• Radiologist (for imaging guidance)
• Anesthesiologist or nurse anesthetist
• Nursing staff

Risks and Complications

• Common risks: Bruising, soreness at the injection site, temporary numbness or weakness in the face
• Rare complications: Infection, excessive bleeding, unintended nerve damage, allergic reaction to the neurolytic agent
• Complication management: Monitoring, antibiotics for infections, and other appropriate medical interventions

Benefits

• Significant reduction or complete relief from chronic facial pain
• Quick improvement in pain levels, often immediately after the procedure

Recovery

• Patients may be observed for a brief period post-procedure before being discharged.
• Mild soreness or swelling at the injection site is normal and may be managed with over-the-counter pain relievers.
• Most patients can resume normal activities within a day or two but should avoid strenuous activities for about a week.
• Follow-up appointments are crucial to assess the effectiveness and monitor for any complications.

Alternatives

• Medications (anticonvulsants, antidepressants)
• Less invasive nerve blocks (e.g., local anesthetic injections)
• Surgical options (microvascular decompression, gamma knife surgery)
• Each alternative has its own set of pros and cons and varying levels of effectiveness and risk.

Patient Experience

During the procedure, patients might feel discomfort or pressure but should not feel significant pain due to local anesthesia and sedation. Post-procedure, there may be temporary numbness, mild pain, or swelling at the injection site. Pain management and comfort measures include the use of ice packs, over-the-counter pain relievers, and rest.