Combination of Preoperative Multimodal Image Fusion and Intraoperative Dyna CT in Percutaneous Balloon Compression of Trigeminal Ganglion for Primary Trigeminal Neuralgia: Experience in 24 Patients

Abstract

ObjectiveWe retrospectively assessed the surgical results of PBC with preoperative multimodal image fusion and intraoperative Dyna Computed Tomography (CT) in 24 patients with primary trigeminal neuralgia (PTN) to explore a valuable aid for Percutaneous balloon compression (PBC).MethodsWe studied the data of 24 patients with PTN. All patients underwent PBC and were assessed with preoperative multimodal image fusion [computed tomography (CT) and magnetic resonance imaging (MRI)] and intraoperative Dyna CT in the Department of Neurosurgery of Zhuhai People’s Hospital between October 2020 and September 2021. Multimodal image fusion—three-dimensional (3D) reconstruction of CT and MRI data—was performed using 3D-Slicer software, and preoperative evaluation was performed according to the results of image fusion. Dyna CT was used to dynamically observe the position and shape of the metallic hollow introducer and Fogarty catheter and balloon during the operation to guide the operation in real time. We performed follow-up assessments each month and summarized the clinical characteristics, surgical effects, and complications in all patients.ResultsSurgery was successful for all patients; the patients reported immediate pain relief. Surgical complications included facial numbness in 24 patients (100%), mild masseter weakness in three (12.5%), herpes zoster in three (12.5%), and balloon rupture in one (4.2%). None of the patients had serious surgical complications. The mean follow-up time was 9.6 ± 2.7 months. During the follow-up period, 22 patients (91.7%) experienced no recurrence of pain, and two patients (8.3%) experienced recurrence of pain, of which one underwent secondary PBC surgery.ConclusionsPreoperative multimodal image reconstruction can help fully evaluate PBC surgery, clarify the etiology, and predict the volume of contrast medium required during the operation. It provided important assistance for PBC treatment of trigeminal neuralgia patients when preoperative multimodal image fusion is combined with intraoperative Dyna CT.

Three-dimensional printing and 3D slicer powerful tools in understanding and treating neurosurgical diseases

“…Especially, 3D Slicer provides high-quality 3D visualization which shows the relationships between nerves and blood vessels in patients with trigeminal neuralgia. That performs a preoperative evaluation for microvascular decompression in clinical practice (76,77). However, due to the limited number of samples, this technology needs more studies with relevant statistical analysis to assess the clinical effect.…”

Clinical application of a three-dimensional-printed model in the treatment of intracranial and extracranial communicating tumors: a pilot study

“…In their previous study, MIF was used to locate the offending vessel of compressed nerves, which helped the surgeons visualize the spatial relationship preoperatively [ 29 ]. They also combined MIF with dynamic CT for evaluation of percutaneous balloon compression surgery, concluding that MIF was helpful [ 30 ]. Through the series of research, it is clear that 3D printing and MIF are both capable of demonstrating spatial information, and considering the printing errors, MIF might even be more advantageous in this aspect.…”

Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences

“…Intraoperative CT can directly verify the accuracy of puncture [ 8 ]. In our study, only C-arm fluoroscopy was used to verify the locations of the needle and catheter.…”

“…What’s more, this procedure could result in some severe complications, which are usually related to foramen ovale puncture [ 5 – 7 ]. For this, many devices and techniques have been used for it [ 8 ]. In current study, we aims to discuss the feasibility and availability of robot-assisted PBC and share our experiences toward it.…”