Bipolar, high-voltage, long-duration pulsed radiofrequency ablation of the Gasserian ganglion for the treatment of trigeminal neuralgia in a patient with a cardiac implantable electronic device: illustrative case

Figures

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  FIG. 1. A: The ECG before the operation in a patient with a CIED Adapta DR (two-chamber) in the asynchronous mode with a heart rate of 80 beats/min. B: The ECG during the operation. C: The ECG 3 hours after operation.

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  FIG. 2. Schematic representation of the GG PRFT procedure. A: Schematic representation of current direction in bipolar radiofrequency ablation: 1, alternating current with 20 ms heat caused by output voltage; 2, alternating current with 480-ms intervals; 3, direction in bipolar radiofrequency ablation where the path of the current does not run through the device and the electrode system; 4, positioning of two needles for radiofrequency ablation of the GG; 5, the CIED. B: Anatomy and topography of the GG: 1, midbrain; 2, pons; 3, medulla; 4, optic nerve; 5, oculomotor nerve; 6, trochlear nerve; 7, root of trigeminal nerve; 8, GG; 9, ophthalmic nerve (first branch of trigeminal nerve); 10, maxillary nerve (second branch of trigeminal nerve); 11, mandibular nerve (third branch of trigeminal nerve); 12, abducens nerve; 13, greater superficial petrosal nerve; 14, internal carotid artery; 15, cavernous sinus; 16, meningeal artery and vein; 17, eye; 18, positioning of two needles for radiofrequency ablation of the GG (the first active tip in the GG; the second active tip in the area of the entrance to the FO).

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  FIG. 3. Real-time CT fluoroscopy. A: Sagittal projection. B: Frontal projection. C: 3D CT reconstruction of the needle positioning in the frontal projection. D: 3D CT reconstruction of the needle tip positions.