Minimally Invasive Trigeminal Ablation: Transoral Approach for Targeting V2

Max Ward; Conor Blanco; Antonios Mammis; Michael Umanoff; Boris Paskhover

doi:10.1016/j.wneu.2018.08.223

Minimally Invasive Trigeminal Ablation: Transoral Approach for Targeting V2

World Neurosurg. 2018 Dec:120:211-213. doi: 10.1016/j.wneu.2018.08.223. Epub 2018 Sep 7.

Authors

Max Ward¹, Conor Blanco², Antonios Mammis³, Michael Umanoff⁴, Boris Paskhover⁵

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address: MaxWard94@gmail.com.
² Saint Barnabas Medical Center, RWJ-Barnabas Health Department of Otolaryngology-Head and Neck Surgery, Livingston, New Jersey, USA.
³ Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
⁴ Department of Anesthesiology, St. Joseph's University Medical Center, Paterson, New Jersey, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

PMID: 30201575
DOI: 10.1016/j.wneu.2018.08.223

Abstract

Background: Trigeminal neuralgia (TN) is a chronic orofacial pain syndrome, which manifests as severe pain in the distribution of any trigeminal nerve branch. Though traditionally responsive to anticonvulsant therapy, TN can become refractory to medications and require surgical intervention.

Case description: We present a case of V2 TN that was treated with minimally invasive trigeminal ablation. The patient presented with a 6-year history of type 1 TN and had failed the maximum tolerated doses of carbamazepine and gabapentin. There was no evidence of vascular compression on neuroimaging. After the patient refused stereotactic radiosurgery, she was offered minimally invasive trigeminal ablation. At 5 months postoperatively the patient reported complete alleviation of pain with tolerable sensorineural numbness.

Conclusions: The endoscopic approach allows for precise targeting of V2, which is ideal in patients undergoing targeted neuroablation for pain. This is the first documented case of a transoral endoscopic approach toward ablative V2 TN management.

Keywords: Endoscopic; MITA; Maxillary Nerve; Minimally Invasive; Transoral; Trigeminal Neuralgia; V2.

MeSH terms

Adult
Catheter Ablation / methods*
Female
Follow-Up Studies
Humans
Minimally Invasive Surgical Procedures / methods*
Postoperative Complications / etiology
Trigeminal Neuralgia / surgery*