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DOI: 10.1055/s-0042-1742426
Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia using a Stereotactic Approach due to a Pterygoalar Bar
Termocoagulação por radiofrequência do gânglio de Gasser na nevralgia do trigêmeo, guiada por estereotaxia devido à presença de barra pterigoalar
Abstract
The treatment of trigeminal neuralgia (TN) consists of pharmacotherapy and neurosurgical procedure, such as percutaneous radiofrequency rhizotomy. Here, we present the case of a patient with TN refractory to clinical treatment who presented an anatomical variation in the oval foramen, which required stereotactic-guided surgery to access the Gasser ganglion.
This is a 63-year-old male patient who presented with TN refractory to drug treatment. He used carbamazepine and nortriptyline, with no satisfactory response. The percutaneous approach to radiofrequency thermocoagulation was indicated, in view of the comorbidities presented and the patient's age. Due to the presence of a rare anatomical variation, stereotactic-guided surgery was used to cannulate the foramen ovale and, thus, successfully perform the neurosurgical procedure with an excellent clinical response. The use of stereotaxy to guide cannulation of the foramen ovale due to anatomical variation was essential for the success of the procedure. The knowledge of the existence of this anatomical variation, and the mastery of the stereotactic technique enabled the adequate management in the face of the unusual situation.
Resumo
O tratamento da neuralgia do trigêmeo (NT) consta de farmacoterapia e procedimento neurocirúrgicos, como a rizotomia percutânea por radiofrequência. Aqui apresentamos o caso de um paciente com NT refratária ao tratamento clínico que apresentava uma variação anatômica no forame oval, o que exigiu a realização de cirurgia guiada por estereotaxia para acesso ao gânglio de Gasser.
Trata-se de um paciente do sexo masculino, com 63 anos de idade, que apresentava quadro de NT refratária ao tratamento medicamentoso. Fez uso de carbamazepina e nortriptilina, sem resposta satisfatória. Foi indicada a abordagem percutânea para termocoagulacão por radiofrequência, tendo em vista comorbidades apresentadas e a idade do paciente. Devido à presença de uma rara variação anatômica, utilizou-se a cirurgia guiada por estereotaxia para canular o forame oval, e, dessa forma, realizar o procedimento neurocirúrgico com sucesso e uma excelente resposta clínica. A utilização de estereotaxia para guiar a canulação do forame oval devido à variação anatômica foi essencial para o sucesso do procedimento. O conhecimento da existência dessa variação anatômica, e o domínio da técnica estereotáxica possibilitaram o adequado manejo frente a uma situação incomum.
Disclosure
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publication History
Received: 22 June 2021
Accepted: 13 October 2021
Article published online:
23 September 2022
© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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