469: Percutaneous Intervention: A Boon for for trigeminal neuralgia due to Vertebrobasilar dolicoectasia

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary orofacial pain, Treatment/management

Background and Aims: Trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD) is a rare but challenging clinical entity caused by ectatic and tortuous vertebrobasilar arteries compressing the trigeminal nerve root entry zone. Management is often difficult due to patient comorbidities and the complex vascular anatomy, limiting the feasibility of microvascular decompression.

Methods: We present a case of refractory trigeminal neuralgia in a patient with radiologically confirmed vertebrobasilar dolichoectasia causing neurovascular compression. The patient had severe, paroxysmal facial pain not adequately controlled with pharmacological therapy. Given high surgical risk and anatomical considerations, percutaneous radiofrequency ablation (RFA) of the Gasserian ganglion was planned.

Intervention: The procedure was performed under fluoroscopic guidance using a standard percutaneous approach via the foramen ovale. Sensory stimulation confirmed appropriate needle placement. Controlled thermal lesioning was carried out at graded temperatures to selectively target pain fibers while minimizing complications.

Results: The patient experienced immediate and significant pain relief post-procedure, with marked improvement in quality of life. Follow-up demonstrated sustained pain control with minimal sensory deficit and no major complications.

Conclusions: Percutaneous radiofrequency ablation is a safe, effective, and minimally invasive therapeutic option for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia, especially in patients who are poor candidates for open surgical procedures. It provides rapid pain relief with an acceptable safety profile and should be considered in the multidisciplinary management of such complex cases.

References: 1. Love S & Coakham HB
Trigeminal neuralgia: pathology and pathogenesis.
Brain. 2001;124(12):2347–2360.
2.Barker FG II et al.
The long-term outcome of microvascular decompression for trigeminal neuralgia.
N Engl J Med. 1996;334:1077–1083.
3.Microsurgical vascular decompression in trigeminal neuralgia caused by ectatic basilar artery.
Neurosurgery. 2008
4.Piatt JH Jr
Trigeminal neuralgia caused by vertebrobasilar ectasia.
Neurosurgery. 1982;10(1):120–124.

5. Tatli M et al.
Various surgical modalities in the treatment of trigeminal neuralgia: literature study of respective long-term outcomes.
Acta Neurochir (Wien). 2008;150:243–255.

6. Kanpolat Y et al.
Percutaneous controlled radiofrequency rhizotomy in the management of idiopathic trigeminal neuralgia: long-term results.
Neurosurgery. 2001;48(3):524–532.

7. Taha JM & Tew JM Jr
Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy.
Neurosurgery. 1996;38:865–871.

Presenting Author: Dr Jyeshtharaj Vidyasagar Patangankar
Submitting Author: Jyeshtharaj Patangankar

Senior Author: Dr Jyeshtharaj Vidyasagar Patangankar

IASP 2026 Global Year theme of Neuropathic Pain: Yes