What is a trigeminal rhizotomy?

A trigeminal rhizotomy is a minimally invasive neurosurgical procedure in which a needle is introduced through the cheek to damage part of the trigeminal nerve called the Gasserian ganglion. This part of the trigeminal nerve is located just inside the bottom of the skull, and it can be accessed through a hole in the skull called the foramen ovale. The trigeminal nerve supplies sensation to the face.

There are three types of trigeminal rhizotomy: radiofrequency, glycerol, and balloon. I select between these three options depending on a patient’s history and symptoms.

Who is this procedure for?

Trigeminal rhizotomy is performed for patients with trigeminal neuralgia or variant disorders. Please visit my trigeminal neuralgia page to learn more about this condition.

I use trigeminal rhizotomy for patients who have bothersome facial pain symptoms despite previous procedures such as a microvascular decompression (MVD). Rhizotomy is less invasive than an MVD, so it is also an excellent primary treatment option for older patients or for patients who prefer to avoid a craniotomy.

Trigeminal rhizotomy is also an excellent urgent surgery option for patients admitted to the hospital with status trigeminus whose pain cannot be controlled with medications alone.

What can a patient expect from the procedure?

Trigeminal rhizotomy is performed as an outpatient/day surgery, meaning that you can go home the same day. There is no incision - just a needle puncture in the cheek. I often perform radiofrequency rhizotomy with the patient only under sedation; otherwise, rhizotomies are performed with the patient asleep with general anesthesia. I will discuss at your office appointment which of these I prefer for you.

I will apply a band-aid or a drop of skin glue to your face. You may shower later in the day after the surgery, and no special wound care is needed.

Facial pain relief from radiofrequency and balloon rhizotomy is rapid and occurs in approximately 90% of patients. Gycerol rhizotomy is similarly effective, but it may take up to a week to take effect.

What are the main risks of the procedure?

The main risks are incomplete facial pain relief and recurrence of the facial pain over time. Patients may need the procedure repeated after a few years if the pain returns. Some facial numbness is expected after a rhizotomy; this usually gets better with time, but it can pose a problem if the numbness involves your eye. I take precautions to avoid this. Importantly, while sensation of the face can be affected, movement of the face is not.