Application of Customized Navigated Template for Percutaneous Radiofrequency Thermocoagulation Treatment of Primary Trigeminal Neuralgia

Abstract

Objective: To investigate the successful rate and accuracy of percutaneous radiofrequency thermocoagulation (PRT) for treatment of primary trigeminal neuralgia (PTN) with customized navigated template via three dimensional (3D) printing technique. Methods: 65 patients with PTN were recruited from January 2014 to March 2015 and randomly divided into two groups: template group (n = 28) and traditional group (n = 37). The patients in traditional group received PRT under guidance of C-arm fluoroscopy, while the ones in template group were treated with customized navigated templates. The data of time, depth and accuracy rate of puncture, the average effective dose equivalent of radiation, complications after operation were collected and analyzed. Results: No intra-operative failures occurred in the template group: the pain was alleviated immediately after operation. Accuracy rate of the template group was 100% while 96% was achieved in traditional group. However, the average time of puncture by the template was significantly reduced compared with traditional group (2.37 ± 0.64 minutes and 24.2 ± 6.55 minutes, respectively; P < 0.001). Meanwhile, the average effective dose equivalent of radiation was apparently reduced compared to the traditional group. The depth of puncture in operation was mostly close to the results of simulation (9.45 ± 0.58 cm and 9.33 ± 0.87 cm respectively, P > 0.05). No complications were observed in template group while several complications such as blooding, leakage of cerebrospinal fluid and dizziness were observed in traditional group. Conclusion: The application of customized template is advocated for improving the accuracy of PRT.

Identifying a Novel Critical Access Difficulty Factor in Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia: Pterygoid Process Ridge

“…For the relationship between the FO therapeutic target accuracy and the rate of initial pain relief, long-term pain relief rate, patients' satisfaction, and postoperative complications, some studies showed statistical significance while others did not. 13,[18][19][20]22 A recurrence rate at 2 years that ranges from 17.1% to 50% [26][27][28] is an important issue affecting the efficacy of radiofrequency thermocoagulation surgery. 29 A primary potential cause of recurrence after PSR is thought to be the lack of the intraoperative puncture needle tip in reaching the location of the nerve fiber bundle that controls pain on the Gasserian ganglion.…”

“…9 A smaller than normal sized FO 10 and the lateral pterygoid plate (LPP) are known to affect the success rate of PSR. 11,12 Currently, the application of assistive devices as neuronavigation, [13][14][15] stereotactic, 5,10,16,17 and 3-dimensional (3D) printing [18][19][20][21][22] is increasingly used for the treatment of TN. We have achieved a high single-puncture success rate of the FO using PSR over the past 9 years.…”

The Long-Term Clinical Outcomes of Selectively Extracranial Radiofrequency Thermocoagulation for Trigeminal Neuralgia Guided by Three-Dimensionally Printed Personalized Template

“…In the present study, we performed selectively extracranial RFT using the 3D printed personalized template. Wang et al 27 firstly reported customized navigated templates for puncture and the accuracy rate of it was as high as 100%. More importantly, the puncture time was greatly reduced and there were no complications related to puncture.…”