Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia using a Stereotactic Approach due to a Pterygoalar Bar

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.