CT-Guided Percutaneous Trigeminal Tractotomy-Nucleotomy for Intractable Craniofacial Pain.
OBJECT
In this report, we aimed to analyze the outcome results of our patients who underwent percutaneous trigeminal tractotomy (TR) and nucleotomy (NC) procedures, which are defined as destructive procedures targeting the descending trigeminal tractus and nucleus caudalis of the spinal trigeminal nucleus, respectively, for intractable craniofacial pain.


METHODS
The medical records of a total of 12 patients who underwent a total of 14 computed tomography (CT)-guided TR-NC procedures at our clinics between 2005 and 2017 were retrospectively reviewed.


RESULTS
A significant increase in patients' performance status (p = 0.015) as well as a significant decrease in the VAS score (p < 0.001) were achieved. Grade I pain relief (VAS = 0, no pain) was established in 66.7% of the patients, whereas grade II pain relief was observed in the remaining patients. Two of the patients suffered from recurrent pain after the initial procedure. Both patients underwent a second trigeminal TR-NC procedure, and grade I pain relief was re-established. The mean VAS score at 3-month follow-up was 1.4 ± 1.1, whereas this score at 6-month follow-up was 2 ± 1.3. The trigeminal TR-NC procedure resulted in a significant decrease in patients' VAS scores at 3- and 6-month follow-up visits compared with preoperative VAS scores (p < 0.001). Transient ataxia was noted in only one patient (8.3%) early after the procedure.


CONCLUSIONS
The results presented in the current study support the efficacy of the percutaneous CT-guided trigeminal TR-NC procedure in the management of intractable facial pain in selected patients. The use of CT guidance allows direct visualization of the target area, thereby enhancing the safety and success of the procedure.
['Bekar|Ahmet|A|', 'Eser Ocak|Pinar|P|', 'Taskapilioglu|M Ozgur|MO|', 'Turkkan|Alper|A|']
D000368:Aged D005157:Facial Pain D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D016343:Monitoring, Intraoperative D010148:Pain, Intractable D011612:Psychosurgery D012189:Retrospective Studies D013238:Stereotaxic Techniques D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D014276:Trigeminal Nerve
Trigeminal tractotomy-nucleotomy Craniofacial pain Trigeminal nerve