Trigeminal neurolysis can be done using alcohol injection or radiofrequency (RF). Other techniques are less commonly performed today. For trigeminal neurolysis a 13-cm 20-gauge styletted needle is generally used. The needle is placed perpendicular to the pupil of the eye with the eye looking straight in front of the patient and the needle directed toward the external acoustic meatus in a cephalad direction. After touching the base of the skull the needle is withdrawn and redirected posteriorly into the foramen ovale. A free flow of CSF should be observed prior to the injection of a test dose of lidocaine and the administration of contrast medium with fluoroscopic guidance; injection of a neurolytic agent can be then performed.
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