Percutaneous gasserian thermocoagulation in the treatment of trigeminal neuralgia
Although percutaneous trigeminal thermocoagulation was first employed in the treatment of tic douloureux in Europe prior to World War II,1 the first major series of cases was not reported in the United States Until 1974.2 Since that time, the procedure has gained increasing acceptance as a safe and effective treatment for trigeminal neuralgia.
We are reporting a series of 53 patients treated at the Cleveland Clinic in the past 3 years.Procedure
The technique used at the Cleveland Clinic is similar to that employed by Sweet and Wepsic,2 although modifications of this technique have been described.3–6 The procedure is carried out with a combination of fentanyl and sodium methohexital (Brevital) anesthesia. The patient is first sedated with 0.05 to 0.1 mg of fentanyl, and then at critical points in the procedure is further anesthetized with 30 to 50 mg of sodium methohexital. We have administered as much as several hundred milligrams of sodium methohexital in divided doses during the procedure. Major discomfort occurs during the introduction of the radio-frequency electrode through the foramen ovale, and later during thermocoagulation of the ganglion. In our experience, this combination of anesthetics produces a maximum degree of comfort, yet allows the patient to be awakened periodically to test the results of stimulation and lesion making.
After the patient is prepared and anesthetized, a radio-frequency thermister electrode (Radionics Inc., Burlington, Massachusetts) is passed through the foramen ovale. The electrode is first introduced into the cheek, and aimed at a point some-what medial to the . . .