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Trigeminal Ganglion RF
Dr. Andre Marques Mansano details, step-by-step, how to perform radiofrequency ablation of the trigeminal ganglion. Using a cadaver, he explains patient positioning as well as the proper oblique and lateral views needed to advance the RF needle into the foramen ovale.
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He also mentions the importance of using both sensory and motor stimulation to ensure the correct branch of the trigeminal is targeted.
To learn more about PSI visit www.painschoolinternational.com.
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I had patient with trigeminal neuralgia. pain. Her pain was on her cheek and just lateral her nose. After rf lesioning, she was pain free until a flu infection. Then after she says she had nose pain but it only starts at night. She never had it during day time. She is taking her tegretol 400 mg. Any comments.
Dr. andre marques mansano a great presentation easy and in the point
that is exactly the technique we use on our pain management department @ Ain Shams university , EGYPT
Please explain how much degree of C Arm in oblique and submental view and also what the tips to find foramen oval in difficult cases and what exact needle position for V1 , V2 ,V3 in submental and lateral view . thanks
Dear Mohamed. Unfortunately there’s no specific oblique angle to find the forame vale. It will varies according to patient anatomy and how much head extension the patient is positioned. In difficult cases I usually focus my “searching” around 2.5 to 3cm lateral to the corner of the mouth (entry point for the blind technique). Regarding the exact needle position for V1, V2 and V3, this is purely sensory stimulation related. V3 is always on the forame vale entrance, if we go further we usually find V2 and V1 is more medial and superior so is easier to reach it entering a little bit lateral and inferior to the forame ovale (if you write me I can send you some pictures – andremarquesmansano@gmail.com). So in lateral view V3 is in the entrance, V2 is halfway and V1 is deep in the cave but we CAN NOT guarantee only with flouro images, we must performa sensory stimulation.
Best
Andre