An image-guided, noninvasive method of cannulation of the foramen ovale for awake, percutaneous radiofrequency rhizotomy

Abstract

The authors describe a simple and low-cost technique for image-guided cannulation of the foramen ovale during treatment of medically refractory trigeminal neuralgia using percutaneous radiofrequency rhizotomy. Computed tomography-guided neuronavigation and the noninvasive ear, nose, and throat Small Active Frame system were applied for visualization of cannulation of the foramen ovale in the awake patient. Use of invasive head-clamp fixation was unnecessary. Three patients were treated using this technique in which the foramen ovale was reached using a single tract. No adverse effects of this technique were reported. The potential benefits and disadvantages of this method are presented.

MRI-Based Radiation-Free Method for Navigated Percutaneous Radiofrequency Trigeminal Rhizotomy

“…6 Yet another group has reported the use of a similar minimally invasive frame attached to the nose, ear, and throat. 28 It is important to note that, although less invasive, these devices are not as tightly attached to the patient's head and therefore may not be as accurate. Because precision is essential for this surgery and method, we recommend using a head clamp for 25 minutes to mount the reference frame on the patient's head, instead of a headband or similar device.…”

Minimizing Technical Failure of Percutaneous Balloon Compression for Trigeminal Neuralgia Using Neuronavigation

“…Various methods have been described for the cannulation of the FO using CT and navigation systems, in order to promote successful insertion with the least possible attempts and avoid complications, as well [12, 18, 19, 23–25]. However, we have not encountered any other paper analyzing the application of a navigation system, without impractical frames or intraoperative imaging systems, specifically for PBC and TN, after technical failure to cannulate the FO under fluoroscopy.…”

“…RF rhizotomy has been applied in almost all studies describing the use of navigation systems in percutaneous procedures for TN [12, 19, 23–25]. According to reviews, PBC is equally effective in the long term and has a lower complication rate (16.1%) than RF rhizotomy (29.2%), especially concerning anesthesia dolorosa and keratitis [8–10].…”

Radiofrequency techniques: Complications and troubleshooting

“…A number of systems have been introduced to increase the accuracy of cannulation, 9,10 in an attempt to lessen the risk of complications.…”