Percutaneous Trigeminal Rhizotomy for Facial Pain Secondary to Head and Neck Malignancy

Abstract

Nearly 80% of patients with head and neck cancers experience facial pain related to their tumor or treatment. The majority obtain pain relief with appropriate medical treatment. Occasionally some remain refractory to all analgesics or cannot tolerate the accompanying side effects. They may benefit from surgical intervention. We report a case of medically intractable facial pain secondary to squamous cell carcinoma of the tongue that was successfully treated with percutaneous trigeminal rhizotomy. Percutaneous trigeminal radiofrequency rhizotomy involves thermoablation of the trigeminal nerve within Meckel's cave by an electrode inserted through the cheek and foramen ovale. Facial pain was successfully controlled postoperatively. Percutaneous trigeminal rhizotomy is a surgical option for managing nociceptive pain secondary to a head and neck malignancy. This technique, last reported in the literature almost 30 years ago, must not be forgotten by the next generation of oncologists, pain specialists, and neurosurgeons.