Operation:

Right percutaneous stereotactic radiofrequency destruction of trigeminal nerve.

Operative Procedure:

After the patient was positioned supine, intravenous sedation was administered. Lateral skull x-ray fluoroscopy was set. The right cheek was infiltrated dermally with Xylocaine, and a small nick in the skin, 2.5 cm lateral to the corner of the mouth, was performed with an 18-gauge needle.

The radio-frequency needle with 2 mm exposed tip was then introduced using the known anatomical landmarks and under lateral fluoroscopy guidance into the foramen ovale.

Confirmation of the placement of the needle was done by the patient grimacing to pain and by the lateral x-ray.

The first treatment, 90 seconds in length, was administered with the tip of the needle 3 mm below the clival line at a temperature of 75 degrees Celsius.

The needle was then advanced further to the mid clival line, and another treatment of similar strength and duration was also administered.

Finally, the third and last treatment was administered with the tip of the needle about 3 cm above the line. The needle was removed.

The patient tolerated the procedure well. (Note: Do not code fluoroscopy).

Case Study 7

005K3ZZ Destruction, Nerve, Trigeminal (005K)

Rationale: Stereotactic radiofrequency is utilized for destruction of the trigeminal nerve. A needle is placed into the right cheek and the radiofrequency is delivered through the needle.