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J Neurol Surg B Skull Base 2024; 85(02): 156-160
DOI: 10.1055/s-0043-1764323
Original Article

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia

Keaton Francis Piper 
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Gabriel Flores-Milan
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Alejandro Matos Cruz
2   Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, United State
,
Jay I. Kumar 
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
,
Harry van Loveren
1   Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
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Abstract

Objective We aim to describe a novel positioning technique using a specific surgical table to achieve the optimal angle during percutaneous glycerol rhizotomy (PGR) for trigeminal neuralgia (TN).

Design This is a descriptive and photographic analysis of successful cases for future implementation.

Setting This study was conducted at a single-institution, academic center.

Participants The participants were adult patients with TN who underwent PGR and provided consent for publication.

Main Outcome Measures Primary outcomes of this study were TN symptomatic relief and surgical complications.

Results The use of a beach chair sliding headboard surgical table for PGR is plausible and ensures precise and immobile head flexion for 1 hour postglycerol injection. There were no intraoperative or postoperative complications. All patients achieved successful reduction of TN symptoms.

Conclusions Utilizing this new method of intraoperative navigation with a unique surgical table in the upright position, surgeons may achieve precise head adjustments post-PGR. Head flexion has been postulated as a means of ensuring glycerol containment in Meckel's cave. This method can help standardize this procedure for future systematic studies on the importance of head positioning post-PGR.

Keywords

percutaneous glycerol rhizotomy - trigeminal neuralgia - trigeminal rhizotomy - gasserian ganglion - Meckel's cave


Publication History

Received: 28 December 2022

Accepted: 01 February 2023

Article published online:
03 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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