Computed tomography-guided trigeminal tractotomy-nucleotomy for refractory chronic craniofacial pain: a case report

Abstract Background Refractory chronic craniofacial pain is a debilitating condition with limited treatment options. This case report presents the use of percutaneous computed tomography-guided trigeminal tractotomy-nucleotomy under general anesthesia in a patient with refractory trigeminal neuralgia and post-treatment anesthesia dolorosa. This case report expands the use of TR-NC to include treatment-resistant post-treatment anesthesia dolorosa and introduces real-time verification under anesthesia, potentially broadening access and improving precision, while highlighting the need for further research on long-term efficacy and patient selection for this promising technique. Case presentation A 50-year-old woman with 12 years of chronic facial pain in the opthalmic and maxillary trigeminal branches despite multiple surgical and medical interventions underwent computed tomography-guided trigeminal tractotomy-nucleotomy under general anesthesia. Initial pain relief was significant, but symptoms gradually returned within 12 months. Transient mild ataxia was the only complication. Conclusion This case suggests trigeminal tractotomy-nucleotomy under general anesthesia with real-time verification may be a valuable option for patients with refractory post-treatment anesthesia dolorosa. However, the transient nature of pain relief necessitates further investigation of long-term outcomes and optimal patient selection.