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

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

Publikationsverlauf

Eingereicht: 28. Dezember 2022

Angenommen: 01. Februar 2023

Artikel online veröffentlicht:
03. März 2023

• References

• 1 Jho HD, Lunsford LD. Percutaneous retrogasserian glycerol rhizotomy. Current technique and results. Neurosurg Clin N Am 1997; 8 (01) 63-74
• 2 van Loveren H, Tew Jr JM, Keller JT, Nurre MA. a 10-year experience in the treatment of trigeminal neuralgia. Comparison of percutaneous stereotaxic rhizotomy and posterior fossa exploration. J Neurosurg 1982; 57 (06) 757-764
• 3 Eide PK, Stubhaug A. Sensory perception in patients with trigeminal neuralgia: effects of percutaneous retrogasserian glycerol rhizotomy. Stereotact Funct Neurosurg 1997; 68 (1–4, Pt 1): 207-211
• 4 Kumar R, Mahapatra AK, Dash HH. The blink reflex before and after percutaneous glycerol rhizotomy in patients with trigeminal neuralgia–a prospective study of 28 patients. Acta Neurochir (Wien) 1995; 137 (1–2): 85-88
• 5 Cheng JS, Lim DA, Chang EF, Barbaro NM. A review of percutaneous treatments for trigeminal neuralgia. Neurosurgery 2014; 10 (Suppl. 01) 25-33 , discussion 33
• 6 Asplund P, Blomstedt P, Bergenheim AT. Percutaneous balloon compression vs percutaneous retrogasserian glycerol rhizotomy for the primary treatment of trigeminal neuralgia. Neurosurgery 2016; 78 (03) 421-428 , discussion 428
• 7 Texakalidis P, Xenos D, Tora MS, Wetzel JS, Boulis NM. Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: A systematic review and meta-analysis. Clin Neurol Neurosurg 2019; 182: 112-122
• 8 Blomstedt PC, Bergenheim AT. Technical difficulties and perioperative complications of retrogasserian glycerol rhizotomy for trigeminal neuralgia. Stereotact Funct Neurosurg 2002; 79 (3–4): 168-181
• 9 Härtel F. Über die intrakranielle injektions behandlung der trigeminusneuralgie. Med Klin 1914; 10: 582-584
• 10 North RB, Kidd DH, Piantadosi S, Carson BS. Percutaneous retrogasserian glycerol rhizotomy. Predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 1990; 72 (06) 851-856
• 11 Bergenheim AT, Hariz MI, Laitinen LV. Retrogasserian glycerol rhizotomy and its selectivity in the treatment of trigeminal neuralgia. Acta Neurochir Suppl (Wien) 1993; 58: 174-177
• 12 Bergenheim AT, Hariz MI, Laitinen LV. Selectivity of retrogasserian glycerol rhizotomy in the treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 1991; 56 (03) 159-165
• 13 Saini SS. Reterogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry 1987; 50 (11) 1536-1538
• 14 Xu-Hui W, Chun Z, Guang-Jian S. et al. Long-term outcomes of percutaneous retrogasserian glycerol rhizotomy in 3370 patients with trigeminal neuralgia. Turk Neurosurg 2011; 21 (01) 48-52
• 15 Bond JD, Xu Z, Zhang H, Zhang M. Meckel's cave and somatotopy of the trigeminal ganglion. World Neurosurg 2021; 148: 178-187
• 16 Arslan M, Deda H, Avci E. et al. Anatomy of Meckel's cave and the trigeminal ganglion: anatomical landmarks for a safer approach to them. Turk Neurosurg 2012; 22 (03) 317-323
• 17 Navarrete Álvaro ML, Puiggròs A, Coscojuela P. Meckel's cave anatomic variation. Eur Arch Otorhinolaryngol 2012; 269 (09) 2153-2154
• 18 Sabancı PA, Batay F, Civelek E. et al. Meckel's cave. World Neurosurg 2011;76(3–4):335–341, discussion 266–267
• 19 Sayaci EY, Kahilogullari G, Comert A. et al. Morphology of the trigeminal ganglion: anatomical structures related to trigeminal radiofrequency rhizotomy. Acta Neurochir (Wien) 2022; 164 (06) 1551-1566