Artikel
Prospective trial on O-Arm®-based visualization und navigated retrogasserian balloon compression for refractory trigeminal neuralgia
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Autoren
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Jan Walter
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
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Rupert Reichart
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
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Rolf Kalff
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: Balloon compression of the Gasserian ganglion for refractory trigeminal neuralgia is besides radiofrequency lesioning a well-established treatment option within percutaneous techniques. Nevertheless, conventional perioperative fluoroscopy poses the problem of targeted and exact puncture of the oval foramen. With the help of an intraoperative O-Arm® based 3D-navigation and online visualization a new method for a precise puncture of the oval foramen is now available and was applied with 12 patients suffering from refractory trigeminal neuralgia
Method: The O-Arm® system is a relatively new, intraoperatively applicable 360° fluoroscopic device, which allows online 3D-imaging and simultaneous navigation. In this prospective trial 12 patients (7 female, 5 male) were treated with percutaneous retrogasserian balloon compression after O-Arm® based navigated puncture of the oval foramen and 3D-imaging for verification of the balloon positioning.
Results: In all patients (12/12) O-Arm® navigated puncture of the oval foramen was technically feasible. In 11/12 cases exact positioning of the cannula and the Fogarty balloon catheter within the oval foramen was achieved at once, whereas in one patient the cannula had to be repositioned after an extraforaminal placement was documented in intraoperative 3D-imaging. During inflation of the balloon, which was controlled by continuous fluoroscopy, we saw an extracranial dislocation in 1 of 12 patients. Compared to conventional fluoroscopy guided balloon positioning, this new technique of navigated guidance and intraoperative visualization leads to a minor (mean: 11min) but statistically not significant prolongation of procedural time. During follow-up, 8/12 patients showed a complete and 4/12 a partial reduction of their trigeminal pain.
Conclusions: In all patients an exact catheter positioning and sufficient compression of the Gasserian ganglion was achieved with the help of intraoperative navigation and 3D-visualization. Therefore the new procedure of an O-Arm® based navigation and simultaneous 3D-visualization during retrogasserian compression is a valuable tool for invasive pain therapy, that is easy to integrate into the OR setup.
