64610 Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring

Name of the Procedure:

Destruction by Neurolytic Agent, Trigeminal Nerve; Second and Third Division Branches at Foramen Ovale under Radiologic Monitoring

Summary

This procedure involves using a neurolytic agent to damage the second and third branches of the trigeminal nerve at the foramen ovale to provide relief from chronic pain. The process is guided by imaging techniques to ensure precision.

Purpose

The procedure is designed to treat chronic facial pain, specifically targeting the trigeminal nerve branches. The goal is to reduce or eliminate pain by destroying nerve fibers that transmit pain signals.

Indications

• Chronic facial pain not responsive to conservative treatments
• Trigeminal neuralgia
• Persistent post-traumatic or post-herpetic neuralgia Suitable for patients who have not responded to medications or other less invasive procedures.

Preparation

• Patients are typically instructed to fast for at least 6 hours before the procedure.
• Certain medications may need to be paused; the healthcare provider will offer specific guidance.
• Pre-procedure diagnostic tests, such as imaging or nerve conduction studies, may be required.

Procedure Description

1. The patient is positioned, often lying down, and an IV line is started.
2. Local anesthesia or mild sedation is administered to ensure comfort.
3. Using radiologic monitoring (like fluoroscopy), the physician inserts a needle through the skin to reach the foramen ovale.
4. A neurolytic agent (such as alcohol, phenol, or glycerol) is injected near the second and third branches of the trigeminal nerve.
5. The agent works to destroy nerve fibers that transmit pain signals, thereby reducing pain.

Duration

The procedure typically takes about 1 to 1.5 hours.

Setting

This procedure is often performed in a hospital setting or an outpatient surgical center.

Personnel

• Pain management specialist or neurosurgeon
• Radiologist (for imaging guidance)
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Temporary or permanent numbness in the treated area
• Infection at the injection site
• Bleeding or hematoma formation
• Allergic reaction to anesthetics or neurolytic agents
• Unintended damage to surrounding tissues

Benefits

• Significant reduction in chronic facial pain
• Improved quality of life
• Results can be immediate, with some patients experiencing pain relief within a few days.

Recovery

• Patients might experience mild discomfort or swelling at the injection site.
• Avoid strenuous activities for a few days.
• Follow-up appointments are scheduled to monitor progress and address any concerns.
• Pain relief can last for months or even years, though some patients may require repeat treatments.

Alternatives

• Medications (anticonvulsants, antidepressants)
• Surgical options (microvascular decompression, gamma knife surgery)
• Nerve blocks or other less invasive procedures Compared to surgery, this procedure is less invasive with a shorter recovery time but may not provide permanent relief.

Patient Experience

During the procedure, patients might feel mild pressure but typically minimal pain due to anesthesia. Post-procedure, there might be some tenderness and swelling at the injection site. Pain management with over-the-counter pain relievers may be recommended, and most patients return to normal activities within a few days.