V2 Rhizotomy

Abstract

Trigeminal neuralgia is a facial pain syndrome characterized by excruciating, paroxysmal, electric shock-like pain attacks in the sensory distribution of the trigeminal nerve. Medical management remains the first line of treatment. When this fails, surgical management needs to be considered. Percutaneous interventional procedures such as glycerol rhizotomy, radiofrequency (RF) thermocoagulation, and balloon compression of the trigeminal ganglion and its branches are some of the most commonly used procedures as they avoid exposure to general anesthesia, provide successful short-term results, and are available to people with significant co-morbidities. Of these, RF is the most often used. The V2 and V3 branches of the trigeminal nerve are most commonly affected, and are thus the most frequent targets for RF interventions. These procedures may be performed using conventional fluoroscopic, ultrasound, or CT-guided imaging, including combined flat-panel CT and fluoroscopy. This chapter summarizes these common ablation techniques targeting the V2 branch of the trigeminal nerve.