Unanticipated complication of percutaneous radiofrequency trigeminal rhizotomy: rhinorrhea: report of three cases and a cadaver study.
OBJECTIVE
Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia: vascular decompression of the trigeminal root in the brainstem, percutaneous trigeminal ganglion procedures, and external beam radiosurgery. Percutaneous radiofrequency electrodes target the trigeminal fibers in the gasserian ganglion through the foramen ovale. Several complications of radiofrequency trigeminal rhizotomy (RF-TR) have been described, including puncture of the carotid artery, the cavernous sinus, and the cranial nerves. This study presents a very rare complication of percutaneous RF-TR, rhinorrhea, and attempts to define its mechanism.


METHODS
Of 2375 patients with idiopathic trigeminal neuralgia who underwent 2958 percutaneous RF-TR procedures, 3 developed subsequent rhinorrhea, which resolved spontaneously in 2 to 3 days.


METHODS
Two formalin-fixed cadavers were dissected to demonstrate the relationship between the foramen ovale and the tuba auditiva and the mechanism of rhinorrhea.


CONCLUSIONS
This article presents a very rare complication of RF-TR. Rhinorrhea and/or cerebrospinal fluid fistulae in the nasopharyngeal cavity are benign complications of RF-TR that result from puncturing both the membranous portion of the tuba auditiva (eustachian tube) and Meckel's cave with the rhizotomy needle.
Ugur
Hasan Caglar
HC
Department of Neurosurgery, Ankara University, Ankara, Turkey. hasanugar@hotmail.com
Savas
Ali
A
Elhan
Alaittin
A
Kanpolat
Yücel
Y
D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019051:Rhizotomy / Q000009:adverse effects*; D014277:Trigeminal Neuralgia / Q000601:surgery*