Uso de la TAC como guía para la neurolisis trigeminal con alcohol.

Uso de la TAC como guía para la neurolisis trigeminal con alcohol.

Use of Computed Tomography Guide for Trigeminal Alcohol Neurolysis Víctor Whizar-Lugo MD, Francisco Anzorena-Vallarino MD, Roberto Cisneros-Corral MD, Ricardo Valdez-Jeres MD, Rogelio Hernández-Velazco DDS. Anest Mex 2008;20:11-13. Trigeminal neurolytic blocks (TNB) are usually guided with fluoroscopy or plain x-ray which gives us only two dimension pictures. Objective. To show our experience with CT guide to perform TNB, on high surgical risk patients with trigeminal neuralgia (TN). Method and patients: Twenty one patients with idiopathic uncontrolled TN, were included. All cases were monitored with EKG, pulse oximetry and NIBP. Local anesthesia with 1% lidocaine, a 22 gauge Quincke type spinal needle, 8.89 cm long was inserted according with the Gasserian ganglion block technique, until the needle tip reached the skull base, or a mandibular paresthesia was elicited. Immediately, a series of CT slides were done to identify the needle tip position. The needle tip was then walked carefully into the foramen ovale, and once a proper position was confirmed with another CT, the stylet was removed. After a negative CSF and blood aspiration proved, a 0.1 to 0.2 mL increments of dehydrated 98% ethanol were injected every 30 seconds up to 1 mL. Results: All cases but two were done as ambulatory procedures. Adequate pain relief was obtained in all but 3 patients. Eighteen patients were able to stop or decrease their previous pain medicines. Analgesia lasted up to 24 months of follow-up. Three individuals did not improve their pain. In one of these 3 cases, neurolysis was repeated but he did not respond to the block, and developed V2 anesthesia dolorosa. Conclusions: The main advantage of CT over fluoroscopy and plain x-ray is the exquisite visualization of the foramen ovale. The accurate placement of the needle tip inside the foramen ovale nullify the chance of injecting the neurolytic improperly, reducing the incidence of side effects. CT guide is more expensive than conventional fluoroscopy or plain x -ray, and requires an expert radiologist. Use of CT guide to perform NTB is an alternative to fluoroscopy. Key words: CT scan guide, trigeminal neurolisis. http://www.anestesiaenmexico.org/RAM9/RAM2008-20-1/004.pdf