gms | German Medical Science

Objective: Trigeminal percutaneous ablative procedures for trigeminal neuralgia have been widely used for large groups of patients, including such methods as alcohol or glycerol injections, balloon compression, and radiofrequency thermocoagulation of the gasserian ganglion. These procedures require cannulation of the foramen ovale and its precise visualization using fluoroscopy is frequently difficult, and it might affect the length of the procedure. We describe our experience about the accuracy, safety and simplicity of using electromagnetic neuronavigation and cone-beam CT in the hybrid OR suite as a guiding technique for cannulation of the foramen ovale in percutaneous trigeminal procedures.

Methods: We retrospectively analysed data from patients with trigeminal neuralgia who had clinical indications for percutaneous trigeminal pain procedures in our hospital from June 2016 to November 2019. Electromagnetic navigation-assisted trigeminal nerve blocks, balloon compression or radiofrequency ablations were performed by using pre-operative brain MRI and/or CT scans. Additionaly, intraoperative DynaCT and/or fluoroscopy was used for foramen ovale cannulation confirmation.

Results: Fourteen patients had 21 procedures during the study period. Most patients were male (n=8, 57.14%) and the age range was from 28-80 years old. Interventions performed consisted of nine balloon compressions, 9 radiofrequency ablations and 3 nerve blocks. The mean duration of the surgical procedure was 31.28 ± 19.85 minutes. Average radiation exposure was 104.22 mGy. Foramen ovale cannulation was successful in all cases and there were no complications.

Conclusion: The combination of electromagnetic neuronavigation and intraoperative DynaCT is a simple, fast, accurate and effective alternative for percutaneous trigeminal nerve procedures.