Ultrasound-guided pulsed radiofrequency application via the pterygopalatine fossa: A practical approach to treat refractory trigeminal neuralgia

Antoun Nader, Bernard Bendok, Jeremy J. Prine, Mark C. Kendall

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Although pharmacological therapy is the primary treatment modality for trigeminal neuralgia associated pain, ineffective analgesia and dose limiting side effects often prompt patients to seek alternative pharmacological solutions such as interventional nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real time visualization of needle placement within the surrounding anatomical structures. The use of ultrasonography with pulsed radiofrequency therapy for trigeminal neuralgia has not been reported. Our case is a 66-year-old male suffering from trigeminal neuralgia for 4 years that was refractory to pharmacologic therapy. Neurological examination was normal with no sensory deficit. Imaging showed no vascular compression or mass involving the trigeminal nerve. A diagnostic ultrasound-guided trigeminal nerve block via the pterygopalatine fossa with 4 mL of bupivacaine 0.25% and 4 mg dexamethasone provided immediate pain relief (100%) with sustained analgesia >50% at 2 weeks. Pain relief was not sustained at one month, with return to pretreatment symptoms. A series of injections were performed with similar intermittent analgesic effectiveness. The decision was made that the patient was a suitable candidate for pulsed radiofrequency application in the pterygopalatine fossa. We successfully used an alternative approach through the pterygopalatine fossa to treat trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates the utility of ultrasound-guidance pulsed radiofrequency treatment in the pterygopalatine fossa as a potential alternative to other percutaneous techniques for patients with medical refractory trigeminal neuralgia.

Original languageEnglish (US)
Pages (from-to)E411-E416
JournalPain Physician
Volume18
Issue number3
StatePublished - 2015
Externally publishedYes

Keywords

  • Facial pain
  • Pulsed radiofrequency
  • Trigeminal nerve
  • Trigeminal neuralgia
  • Ultrasound-guided

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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