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

Thatikunta, Meena; Eaton, Jessica; Nuru, Mohammed; Nauta, Haring J.W.

doi:10.7759/cureus.8100

Cited by 7 publications

(14 citation statements)

References 14 publications

(19 reference statements)

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“…4 Given its technical challenge and lack of CSF return in some cases, making the conventional fluoroscopic confirmation of adequate cannulation less certain, some studies have proposed salvage procedures using CT-and MRI-guided navigation and frameless navigation to overcome these challenges for accurate cannulation of the foramen ovale and Meckel's cave with improving outcomes. [21][22][23] Minimally invasive procedures and approaches have been used to treat various neurosurgical diseases. 9 Over the past decade, endoscopic approaches have gained popularity and have been used for spinal, transcranial, and skull base approaches.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopically-Assisted Percutaneous Trigeminal Rhizotomy for Trigeminal Neuralgia: A Cadaveric Feasibility Study

et al. 2023

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Objective Trigeminal neuralgia (TN) is a debilitating syndrome characterized by paroxysmal facial pain in one or more divisions of the trigeminal nerve. The etiology and treatment paradigms are still controversial. The endoscopically-assisted procedure has not yet been described in percutaneous procedures for TN. The aim of this study was to assess the utility and feasibility of endoscopic-assisted percutaneous approaches for trigeminal rhizotomy in TN. Methods This study comprised eight cadaveric sides heads that underwent an endoscopically assisted percutaneous approach using Hakanson's anterior puncture method for targeting the foramen ovale. Results V3 exiting the foramen ovale was easily visualized with the endoscope on all sides. While approaching the foramen ovale, distal branches of V3 such as the lingual and inferior alveolar nerves were first identified as they traveled between the medial and lateral pterygoid muscles. These branches were then traced proximally to the V3 trunk deep to the lateral pterygoid. Large arteries and veins were easily visualized and avoided in the trajectory to the foramen ovale. No gross injury to any neurovascular structure along the course of the needle insertion was identified. Conclusion We found that endoscopic-assisted percutaneous approach to the foramen ovale is feasible and allows for accurate canalization and anatomical identification of the precise location for rhizotomy under direct visualization. Such a procedure, after it is confirmed in patients, could offer a new technique for reducing unsuccessful canalization and could improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endoscopically-Assisted Percutaneous Trigeminal Rhizotomy for Trigeminal Neuralgia: A Cadaveric Feasibility Study

et al. 2023

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Massager

Pouleau

Jodaïtis

et al. 2022

European Journal of Pain

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Background: Thermic rhizolysis is a reliable therapy for pharmaco-resistant trigeminal neuralgia (TN). Temperature, duration of electrocautery and needle location can influence the efficacy and complications of the therapy. Methods:We performed experimental thermocautery on egg white with increasing parameters of time (30-120 s) and temperature (60-95°C); we analysed the shape, size and volume of the thermic lesions produced. We developed a surgical procedure to assess peroperatively the probable thermocoagulation field and its geometric relations with the trigeminal roots and other anatomical structures of Meckel's cave, and we individually adapted the parameters of rhizolysis to optimize the results. This procedure was applied on 22 patients with TN. Results:The volume of the lesions produced by rhizolysis on egg white had a spheroidal shape and increased linearly with the level of temperature and the time of electrocautery from 1.595 mm 3 (SD 0.38) to 54.454 mm 3 (SD 10.41); higher temperatures induced larger thermocoagulation fields than longer time periods.The calculated volumes measured at all levels of temperature and time were applied in vivo on the patient stereotactic planning during the thermocoagulation procedure in order to select the optimal parameters for rhizolysis. The median values used were 75°C (range 70-85°C) and 60 s (range 45-60 s). At 6-month follow-up, pain outcome was Barrow-Neurological-Institute class-I for 72.7%, IIIa for 22.7% and IIIb for 4.6%; the only complication due to rhizolysis was mild facial numbness in 13 subjects (59%) at 6-month follow-up. Conclusion: We conclude that geometric analysis of the position of the electrode before trigeminal thermocoagulation with morphometric-related individual adaptation of treatment parameters could avoid serious injuries and optimize pain control. Significance: We have adapted the technique of radiofrequency rhizolysis for TN. Our procedure allows individual peroperative adaptation of the parameters of thermocoagulation, according to the specific position of the electrode during rhizolysis. Preliminary results on a series of 22 patients have shown promising results.

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“…3 Previous studies showed the utility of 3-dimensional (3-D) intraoperative computerized tomography (CT)-based or MRI-based neuronavigation in improving the accuracy of needle localization and trajectory. [4][5][6][7][8] The purpose of this study was to assess the benefit of incorporating 3-D augmented reality (AR) into the planning and performance of these percutaneous procedures. AR overlays virtual content on the real world and therefore has the potential to improve localization of surgical targets that are unexposed to the human eye.…”

mentioning

confidence: 99%

Augmented Reality–Assisted Percutaneous Rhizotomy for Trigeminal Neuralgia

Berger

Choudhry

Kondziolka

2023

Operative Neurosurgery

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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.

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

Cited by 7 publications

References 14 publications

Endoscopically-Assisted Percutaneous Trigeminal Rhizotomy for Trigeminal Neuralgia: A Cadaveric Feasibility Study

Endoscopically-Assisted Percutaneous Trigeminal Rhizotomy for Trigeminal Neuralgia: A Cadaveric Feasibility Study

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

Augmented Reality–Assisted Percutaneous Rhizotomy for Trigeminal Neuralgia

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