gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Article

Send article

An MRI based radiation-free method for navigated percutaneous radiofrequency trigeminal rhizotomy

Meeting Abstract

Search Medline for

  • Guilherme Lepski - Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Matthias Morgalla - Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Kristopher Ramina - Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Paulo Mesquita Filho - Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Sotirius Bisdas - Department of Neuroradiology, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Ulrike Ernemann - Department of Neuroradiology, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Marcos Tatagiba - Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany
  • Günther Feigl - Department of Neurosurgery, University Clinic of Tübingen, Eberhard Karls University, Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 100

doi: 10.3205/14dgnc496, urn:nbn:de:0183-14dgnc4968

Published: May 13, 2014

© 2014 Lepski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: 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. Recently, neuronavigation has been proposed as a method to increase the procedure's safety. All of the techniques described so far rely on pre- or intraoperative CT scanning. Here we present a simple MRI-based (radiation-free) method used to target the foramen ovale under navigation guidance.

Method: We retrospectively analyzed 9 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 a) pain free, b) more than 70% pain reduction, and c) 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 is especially recommended for young, inexperienced neurosurgeons.