What is a Trigeminal Tractotomy?
Sensory information is constantly being being transmitted to our spinal cord for various parts of the body. Trigeminal tractotomy is a procedure used to halt pain signals from reaching the topmost sections of the spine through the creation of lesions.
Who needs Trigeminal Tractotomy?
This procedure may benefit those who suffer from severe facial, neck, or head pain due to cancer, trauma, or other serious conditions. This procedure may treat that pain if medication does not provide satisfactory relief or has unacceptable side effects.
How is it performed?
Before the Procedure
The patient should fast for 5 hours before the procedure. Anesthesia is given to a point where the patient is able to give feedback on how certain stimulation feels. Half an hour before the procedure, a contrast material is administered into the spinal cord or via lumbar puncture, if the patient's condition allows it. Measurements are then taken to determine the precise area where nerve tissue is to be removed. The patient is then placed face down on a Computerized Tomography, or CT, table, with his or her head immobilized and spine kept straight. The CT table is used for image guidance during the procedure.
Using the image guidance provided by the CT table, the surgeon inserts the needle into the neck, in the first level of the cervical section of the spine. The needle used is part of a specially designed radiofrequency system that uses specially designed needles and electrodes that can cause electrical stimulation or creation of lesions.
Electrical stimulation is used to determine the correct area to place perform the tractotomy. The patient is continually monitored, and the patient's response to the stimulation is observed to determine correct placement for the tractotomy.
Once the surgeon has determined the correct placement, the patient is given anesthesia so they are not awake for the remainder of the procedure. Then, using the needle-electrode system, lesions are created to block the pathway pain signals use to reach the brain.
After the Procedure
Because this procedure is minimally invasive, recovery time is usually not as long as it would be with a more traditional, or open, version of this procedure. After the procedure, the patient is at minimum kept overnight for observation. Morphine-type painkillers are often decreased, but the gradual reduction will be supervised by your doctor.