KETUT NGURAH GUNAPRIYA MD FIPPFK UB RSSA MALANG

TRIGEMINAL NEURALGIARADIOFREQUENCY ABLATION

INERVATION

TRIGEMINAL NERVE ANATOMY

FUNCTIONAL ANATOMY

PREVALENSI

AGE OF ONSET

More than 70% of patients with TN are over 50 years of age at the time onset

DISTRIBUTION OF PAIN BY DIVISION

DISTRIBUTION

DIAGNOSA

DIAGNOSA

DIAGNOSA

TREATMENT• Medication• Carbamezapine 400-800 mg\day• Gabapentin -900- 2400 mg/day• Phenytoin – 300-500mg/day• Oxcarbazepine – 900-1800mg/day

• Baclofen ( 5 mg orally 3 times a day for 3 days, then 10 mg orally 3 times a day for 3 days, then 15 mg orally 3 times a day for 3 days, then 20 mg orally 3 times a day. Maintenance dose: 40-80 mg/day. 80 mg/day doses should be administered in 4 divided doses.)

CLINICAL PRACTICE ALGORITHM

Medication treatment gives insufficient pain relief/ intolerable side

effects

Young patient

MVD

Elderly patient

RF

PATIENT SELECTION

OVERVIEW STEPS

SUBMENTAL VIEW OBLIQUE

Submental view: Approximately 30o caudal and 30o lateralNeedle directed towards foramen ovale

TUNNEL VISION

LATERAL VIEW

LATERAL VIEW

LATERAL VIEW

JUST ENTER FORAMEN OVALE

ENTER FORAMEN OVALE

FINAL POSITION

AP VIEW

Directed towards ipsilateral pupil in AP view and midpoint of zygomatic arch in lateral view

WALKING THE BONE

CSF FLOW

CANULE RF

SUMMARY

THANK YOU

DEDICATED to my beloved CHEETAH…