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

Abstract

Background Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) is a well-established treatment for patients suffering from trigeminal neuralgia (TN) as a primary modality or for those refractory to medical treatment. However, few existing studies have identified intraoperative parameter or navigation technique that can be used to predict the rates of short-term or long-term pain relief. In this study, we analyzed patient characteristics, intraoperative parameters and technical factors, and postoperative changes in relation to immediate and long-term pain relief. Method This study included a total 252 patients in which 340 RF-TR were performed under the guidance of intraoperative computed tomography (iCT) alone or with magnetic resonance image (MRI) and iCT fusion imaging. Result The immediate pain relief of RF-TR with iCT alone and iCT with MR image guidance with or without cerebrospinal fluid (CSF) outflow were all above 90.4%. The 2-year pain relief rate of RF-TR using iCT alone and iCT with MR images guidance with or without CSF outflow were 47.8%, 39.8%, 71.7%, and 53.9% respectively. Significant factors for 2-year pain relief were CSF outflow, iCT with MR image fusion, non-recurrent TN, and presence of postoperative facial numbness. Conclusion This preliminary study demonstrated foramen ovale cannulation under the aid of iCT with MR image guidance could improve 2-year pain relief.

Factors Associated With Long‐Term Risk of Recurrence After Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion for Patients With Trigeminal Neuralgia Involving the Ophthalmic Division: A Retrospective Study

“…Compared with our previous research, the recurrence rate was lower than that with RFT for patients with TN 3 . The other reported recurrence rate for TN with isolated or concomitant V1 division was 30% to 60% after RFT, and no correlation was found with RFT temperature, which was consistent with our findings 16 . It showed again that RFT was an effective technique in the long term for TN involving the ophthalmic division.…”

A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia

“…Meng et al [ 43 ] described virtual reality-assisted RFT, although they did not record the one-puncture success rate, puncture time, or operation time. Tsai et al [ 44 ] used intraoperative CT with magnetic resonance image fusion to guide RFT. This method improved the 2 year pain relief and avoided puncture-related complications.…”

Application of morphological characteristics of radiofrequency lesions to individual parameters of thermal rhizolysis for trigeminal neuralgia

“…These new features in the procedure of RF rhizotomy of the gasserian ganglion have concerned facilitation of cannulation of the foramen ovale. More recently, another major improvement in the technique has emerged and aimed at placing the tip of the electrode at an optimal area inside the Meckel's cave (Thatikunta et al, 2020;Tsai et al, 2019). For this, a stereotactic planning system and a combination of preoperative MRI and intraoperative CT were used to provide visualization of the electrode into the Meckel's cave.…”

“…The procedure of RF thermocoagulation is usually performed under the guidance of fluoroscopy. More recently, some reports have been published on the use of computed tomographic or navigation guidance, or both (Arishima et al, 2016;Easwer et al, 2016;Lin et al, 2011;Thatikunta et al, 2020;Tsai et al, 2019;Weßling & Duda, 2019;Yang et al, 2010). These new systems can facilitate cannulation of the foramen ovale, especially for less experienced surgeons.…”

“…Radiofrequency (RF) thermocoagulation has been used clinically as a modality to treat various chronic pain syndromes since the 1950s (Mullan et al, 1963). Currently, it is one of the most frequently used neurolytic techniques for the relief of pain (Vanneste et al, 2017). High‐frequency electrical current is applied adjacent to the structure of the nerve that is to be ablated, leading to ionic oscillation and frictional dissipation of the ions and electrolytes, which produces heat.…”