3D Image-Guided Percutaneous Radiofrequency Thermocoagulation of the Maxillary Branch of the Trigeminal Nerve Through Foramen Rotundum for the Treatment of Trigeminal Neuralgia

Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion through the foramen ovale is a well-established procedure for the treatment of trigeminal neuralgia (TN). However, this approach can be tricky when individual trigeminal sub-branch nerve block is required. We report our initial experience of image-guided radiofrequency thermocoagulation of the maxillary branch through the use of foramen rotundum. From February 2012 to February 2015, we treated 25 patients with isolated TN of the maxillary branch. Radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum was performed under fluoroscopy. TN pain was evaluated using the visual analogue scale both before and after the procedure. The mean preoperative visual analogue scale score was 8.6 ± 0.8. The pain completely disappeared after the initial procedure in 22 patients and after a second procedure in 2 patients. An additional patient had a postoperative visual analogue scale score of 2 and did not undergo further treatment. Facial numbness occurred in 23 patients but was tolerable. Patients were followed up for a mean of 14.74 months (range, 1–29 months). Recurrence was observed in 9 patients (36%) during the follow-up period. All recurrences were well managed with repeat procedures. Percutaneous radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum under fluoroscopy is a safe and effective procedure for the treatment of isolated TN of the maxillary branch.