MRI-Based Radiation-Free Method for Navigated Percutaneous Radiofrequency Trigeminal Rhizotomy

Guilherme Lepski; Paulo Moacir Mesquita Filho; Kristofer Ramina; Sotirios Bisdas; Ulrike Ernemann; Marcos Tatagiba; Matthias Morgalla; Guenther Feigl

doi:10.1055/s-0034-1394190

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2015; 76(02): 160-167
DOI: 10.1055/s-0034-1394190

Technical Note

Georg Thieme Verlag KG Stuttgart · New York

MRI-Based Radiation-Free Method for Navigated Percutaneous Radiofrequency Trigeminal Rhizotomy

Authors

Guilherme Lepski

¹Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
Paulo Moacir Mesquita Filho

²Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany
Kristofer Ramina

²Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany
Sotirios Bisdas

³Department of Neuroradiology, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany
Ulrike Ernemann

³Department of Neuroradiology, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany
Marcos Tatagiba

²Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany
Matthias Morgalla

²Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany
Guenther Feigl

³Department of Neuroradiology, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Baden-Würtemberg, Germany

Abstract

Background/Study Aims Percutaneous radiofrequency trigeminal rhizotomy (RTR) is a standardized treatment for trigeminal neuralgia, yet it has been associated with serious complications related to the cannulation of the foramen ovale. Some of these complications, such as carotid injury, are potentially lethal. Neuronavigation was recently proposed as a method to increase the procedure's safety. All of the techniques described so far rely on pre- or intraoperative computed tomography scanning. Here we present a simple method based on magnetic resonance imaging (MRI) (radiation free) used to target the foramen ovale under navigation guidance.

Patients/Material and Methods We retrospectively analyzed nine patients who had undergone navigated percutaneous RTR based solely on preoperative MRI and compared them with 35 patients who underwent conventional RTR guided by fluoroscopy. We analyzed immediate and late outcome and categorized the results into pain free, > 70% pain reduction, and persistent pain. We also compared groups in terms of the duration of the procedure and the complication rates. Here we describe the navigation method in detail and review the anatomical landmarks for target definition.

Results The duration of the surgical procedure was similar in both groups (32.1 in the standard technique versus 34.5 minutes with navigation; p = 0.5157). There was no significant difference between groups regarding pain reduction at the immediate (p = 1.0) or late follow-up (p = 0.6284) time points. Furthermore, no serious complications were observed in the navigated group.

Conclusions We present a simple radiation-free method for neuronavigation-assisted percutaneous RTR. This method proved to be safe and effective, and it is especially recommended for young, inexperienced neurosurgeons.

Keywords

trigeminal neuralgia - neuronavigation - high-resolution MRI - percutaneous rhizotomy

Full Text

References

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