Postherpetic Neuralgia of the Trigeminal Nerve (Trigeminal Tractotomy-Nucleotomy)

Trigeminal tractotomy-nucleotomy (TR-NC) is an effective operation in conditions where peripheral ablation would not be effective or when pain is due to involvement of multiple cranial nerves. Lesioning of the entire nucleus caudalis at the dorsal root entry zone (DREZ) represents a more extensive version of TR-NC. Here the focus is on the less invasive, percutaneous TR-NC or “mini-caudalis DREZ”. The target of TR-NC is the lateral descending trigeminal tract and nucleus caudalis of the spinal trigeminal nucleus. In select patient populations, careful lesion creation can be highly effective in providing immediate and long-lasting pain relief, with minimal adverse effects, lower cost and shorter hospital stays.