Application of MRI and intraoperative CT fusion images with integrated neuronavigation in percutaneous radiofrequency trigeminal rhizotomy

Abstract

This preliminary study demonstrated that the application of MRI and iCT fusion could help with anatomical localization of the trigeminal cistern intraoperatively. The improvement in neuronavigation provides a choice in the treatment of recurrent or persistent trigeminal neuralgia after previous intervention. Long-term follow-up of the result is necessary to evaluate the benefit in terms of durability of therapeutic efficacy.

Foramen ovale cannulation guided by intraoperative computed tomography with magnetic resonance image fusion plays a role in improving the long-term outcome of percutaneous radiofrequency trigeminal rhizotomy

“…Neuronavigation is a widely adopted technology in modern neurosurgery [ 3 , 4 , 6 , 9 , 11 , 17 , 18 , 27 , 28 , 35 , 36 ]. The trajectory for RF-TR is chosen along an unobstructed linear pathway through the foramen ovale, and the placement of needle tip usually does not exceed the clival line confirmed by fluoroscopy [ 4 , 11 , 18 ].…”

“…Postoperative facial numbness was a bothering and unavoidable state following successful thermal lesioning in our study; this finding is consistent with other reports [5, 31]. The position of needle should be in the gasserian ganglion or in the triangular plexus [31], which measures approximately 5.8–6.3 mm from the foramen ovale in cadaver studies [2, 15]; the use of MRI fusion enabled direct anatomical localization of the gasserian ganglion, with a safe needle penetration of up to 9.24 mm beyond the endocranial margin of the foramen ovale compared to 4.06 mm using iCT neuronavigation alone [6], this technique effectively eliminated all puncture-related complications in our study. While ablation temperature is correlated with lesioning complications, this was not found in our study probably because of the accurate positioning of the needle.…”

“…RF-TR with intraoperative computed tomography (iCT) navigation became the treatment of choice in our center since August 2010, which progressed further to include fusion images of computed tomography and magnetic resonance image (MRI); this progression was based on the fact that prior image guidance techniques only allowed the accurate cannulation of the foramen ovale, whereas the inclusion of MRI enabled visualization of the trigeminal cistern and ganglion, which we hypothesize could facilitate better anatomical localization of the target for lesioning. We have shown that this technique can shorten the procedure time and is easy to master, and although short-term pain relief is demonstrated, the long-term advantage of the added image assistance remains unknown [ 6 , 17 ]. In this study, we assessed the efficacy of RF-TR under the guidance of MRI and iCT fusion imaging and explored factors that are associated with long-term outcome and complications.…”

Intraoperative CT for Neuronavigation Guidance and Confirmation of Foramen Ovale Cannulation for Glycerol Trigeminal Rhizotomy: A Technical Report and Case Series

“…Multiple groups have demonstrated the use of intraoperative neuronavigation with CT and/or MRI in radiofrequency ablation for trigeminal neuralgia, with one group reporting a statistically significant difference in the distance they advanced the needle using navigation versus fluoroscopy, implying more accurate localization and trajectory [4][5][6]7]. In 2014, Georgiopoulos et al presented a technical report on five patients who underwent unsuccessful fluoroscopy-guided cannulation and subsequent successful CT-guided cannulation for balloon compression rhizotomy [2].…”

Evaluation of the anatomical accuracy of the neuronavigation system StealthStation in neurosurgical operations

“…(Bohnstedt, Tubbs et al 2012) Interestingly, a few papers were published after our report, but they still used intraoperative CT devices or in the case of Chen et al an impractical navigation method employing a thermoplastic facial mask with fiducials. (Chen, Gu et al 2010, Chen, Gu et al 2013, Aydoseli, Akcakaya et al 2015, Chen, Lin et al 2015, Qiu, Liu et al 2017 Although in one of the later reports the authors used solely navigation, without intraoperative imaging systems or special targeting/navigation devices/adjuncts, they applied RFT, not PBC, and used preoperative head MRI scan. (Lepski, Mesquita Filho et al 2015) In general, PBC is an advantageous method.…”