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

Mansour Mathkour; Cassidy D. Werner; Robert F. Dallapiazza; Marios Loukas; Joe Iwanaga; Aaron S. Dumont; R Shane Tubbs

doi:10.1055/s-0043-1761230

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 040-044
DOI: 10.1055/s-0043-1761230

Original Article

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

Mansour Mathkour

¹Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

²Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, United States

³Division of Neurosurgery, Department of Surgery, Jazan University School of Medicine, Jazan, Kingdom of Saudi Arabia

,

Cassidy D. Werner

⁴Tulane University School of Medicine, New Orleans, Louisiana, United States

,

Robert F. Dallapiazza

¹Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

,

Marios Loukas

⁵Department of Anatomical Sciences, St. George's University, St. George's, Grenada

,

Joe Iwanaga

¹Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

⁶Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

,

Aaron S. Dumont

¹Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

,

R Shane Tubbs

¹Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

²Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, United States

⁵Department of Anatomical Sciences, St. George's University, St. George's, Grenada

⁶Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, United States

⁷Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, United States

› Institutsangaben

Abstract

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.

Keywords

trigeminal neuralgia - anatomy - cadaver - endoscopy

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Referenzen

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