Augmented Reality–Assisted Percutaneous Rhizotomy for Trigeminal Neuralgia

Abstract

BACKGROUND:Percutaneous rhizotomy of the trigeminal nerve is a common surgery to manage medically refractory trigeminal neuralgia. Traditionally, these procedures have been performed based on anatomic landmarks with fluoroscopic guidance. Augmented reality (AR) relays virtual content on the real world and has the potential to improve localization of surgical targets based on preoperative imaging.OBJECTIVE:To study the potential application and benefits of AR as an adjunct to traditional fluoroscopy-guided glycerol rhizotomy (GR).METHODS:We used traditional fluoroscopy-guided percutaneous GR technique as previously described, performed under general anesthesia. Anatomic registration to the Medivis SurgicalAR system was performed based on the patient's preoperative computerized tomography, and the surgeon was equipped with the system's AR goggles. AR was used as an adjunct to fluoroscopy for trajectory planning to place a spinal needle into the medial aspect of the foramen ovale.RESULTS:A 50-year-old woman with multiple sclerosis–related right-sided classical trigeminal neuralgia had persistent pain, refractory to medications, previous gamma knife stereotactic radiosurgery, and percutaneous radiofrequency rhizotomy performed elsewhere. The patient underwent AR-assisted fluoroscopy-guided percutaneous GR. The needle was placed into the right trigeminal cistern within seconds. She was discharged home after a few hours of observation with no complications and reported pain relief.CONCLUSION:AR-assisted percutaneous rhizotomy may enhance the learning curve of these types of procedures and decrease surgery duration and radiation exposure. This allowed rapid and correct placement of a spinal needle through the foramen ovale.

Anatomic Variations of Foramen Ovale as a Predictor of Successful Cannulation in Percutaneous Trigeminal Rhizotomies

“…CT-navigational guidance has become a more common practice, increasing cannulation success, reducing complications, and enhancing overall safety in percutaneous trigeminal rhizotomies. 14,15,[25][26][27][28][29][30][31][32][33][34][35] Given that these patients will often have a preoperative thin-cut CT scan, examining the FO before committing to a percutaneous procedure is a reasonable approach for the clinician. For instance, radiofrequency ablation for TN uses a smaller-diameter Tuohy needle (22G or 23G) compared with the Tuohy needle for balloon compression (14G).…”