Electromagnetic neuronavigation for the percutaneous treatment of trigeminal neuralgia with balloon compression: technical note and cadaveric validation study

Abstract

EM-based targeting of the foramen ovale and balloon inflation within Meckel's cave is a quick, reproducible and straightforward technique for the percutaneous treatment of trigeminal neuralgia.

Comparison of Effectiveness and Safety between Intraoperative 3D-CT-Guided and C-Arm-Guided Percutaneous Balloon Compression for Idiopathic Trigeminal Neuralgia: A Multi-Center Retrospective Study

“…In this study, we did not compare 3D-CT with other 3D visual methods, such as Dyna-CT and neuronavigation, because the devices for these imaging techniques were not available in either of the participating centers. Although 3D-CT can provide only semi-real-time guidance, the high success rate of FO puncture was significantly different from the rates in previous reports, which stated that only 18% of neurosurgeons in training felt they would be able to perform the FO cannulation independently and FO cannulation with x-ray imaging alone could have a failure rate as high as 15%, indicating that correction of the needle after a CT scan facilitated FO puncture [ 12 , 25 ]. The results concerning puncture were in accordance with previous studies on spiral CT-assisted radiofrequency treatment for TN [ 18 , 22 ].…”

“…Among these surgical options, PBC is a commonly used microinvasive technique and shows potential in the control of TN [6,9,10]. However, PBC involves the cannulation of foramen ovale (FO) which requires clinicians to overcome a challenging learning curve and is a very important procedural component [11][12][13][14]. Incorrect cannulation can hinder the success of PBC, and repeated attempts to achieve correct needle placement may cause severe complications [15].…”

“…In addition, 2-4% of patients reportedly have significant anatomic variations in the FO, making PBC an especially difficult procedure in these patients [13,16,17]. Clinicians are continuously searching for visual methods to help identify the puncture route and validate the positions of both the FO and the balloon to obtain more reliable puncture results and better PBC results [12,[14][15][16]18]. Monoplanar and biplanar x-ray fluoroscopy was the first introduced [12,19,20].…”

“…Clinicians are continuously searching for visual methods to help identify the puncture route and validate the positions of both the FO and the balloon to obtain more reliable puncture results and better PBC results [12,[14][15][16]18]. Monoplanar and biplanar x-ray fluoroscopy was the first introduced [12,19,20]. In recent years, C-arm imaging has become a common assistive tool for this procedure.…”

“…In recent years, C-arm imaging has become a common assistive tool for this procedure. More advanced methods such as Dyna-CT and neuronavigation have also been reported to be helpful [11][12][13][14]. Recently, Mendes et al reported that intraoperative CT guidance was useful in the puncture of narrow or difficult-to-access FO [17,21].…”