Modification to the Hartel Route Radiofrequency Technique for the Treatment of Trigeminal Neuralgia: A Technical Note

-OBJECTIVE: To evaluate a modification to the classical Hartel technique for the treatment of trigeminal neuralgia. -METHODS: Intraoperative radiographs of 30 patients with trigeminal neuralgia treated with radiofrequency were retrospectively reviewed. The distance between the needle and the anterior edge of the temporomandibular joint (TMJ) was measured on strict lateral skull radio-graphs. Surgical time was reviewed, and clinical outcomes were evaluated. -RESULTS: All patients showed clinical improvement in pain (Visual Analog Scale). In all radiographs, the mea-surement between the needle and the anterior edge of the TMJ ranged from 10 mm to 22 mm. None of the measure-ments were below 10 mm or above 22 mm. In most cases, this distance was 18 mm (9 patients), followed by 16 mm in 5 patients. -CONCLUSIONS: Considering the inclusion of the oval foramen in a Cartesian coordinate system with axes X, Y, and Z is useful. Directing the needle to a point located 1 cm from the anterior edge of the TMJ, avoiding the medial aspect of the upper jaw ridge, allows for a safer and faster procedure.

Automated summary

This study evaluated a modification to the classical Hartel technique for treating trigeminal neuralgia. Intraoperative radiographs of 30 patients treated with radiofrequency were reviewed retrospectively. The distance between the needle and the anterior edge of the temporomandibular joint (TMJ) was measured, and clinical outcomes were evaluated. The results showed clinical improvement in pain for all patients, with the majority having a distance of 18mm between the needle and the anterior edge of the TMJ. The conclusion suggests that considering the oval foramen in a Cartesian coordinate system and directing the needle to a point 1cm from the anterior edge of the TMJ can facilitate a safer and faster procedure.