Article
Cone-beam CT-navigated percutaneous balloon compression for trigeminal neuralgia
Computertomographisch-navigierte, perkutane Ballonkompression bei Trigeminusneuralgie
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Authors
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Aaron Lawson McLean
- Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
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Kim Di Vincenzo
- Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
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Christian Senft
- Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
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Falko Schwarz
- Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Percutaneous balloon compression (PBC) of the retrogasserian rootlets is an established procedure for the treatment of refractory trigeminal neuralgia (TN), capable of offering immediate and durable pain relief. Intraoperative CT-based navigation to assist with Fogarty catheter passage to the Gasserian ganglion via the foramen ovale has improved the accuracy and safety of this procedure in comparison with a landmark-based approach, with lower radiation exposure than traditional fluoroscopy. This study sought to determine the impact of anatomical and morphometric differences in the foramen ovale on operative parameters, cannulation success rate and the effectiveness of PBC.
Methods: Consecutive adult patients with typical or atypical TN treated with cone-beam CT-navigated (CBCT) PBC between April 2012 and August 2020 were identified from the departmental database. Demographic, clinical and operative parameters were extracted for each case, including duration of surgery, number of foramen ovale cannulation attempts, size of catheter used and total intraoperative radiation exposure. Preoperative CT imaging was reviewed to obtain two- and three-dimensional anatomical measurements pertaining to the foramen ovale for each patient (Figure 1 [Fig. 1]).
Results: 30 patients (ages 31 to 90) received CBCT PBC during the study period. None of the foramen ovale morphometric parameters ascertained had a statistically significant effect on the number of attempts required to cannulate the foramen, the likelihood of ultimately successful cannulation or the intraoperative radiation exposure. However, surgical duration was reduced in cases with greater two-dimensional length and width of the foramen entry zone (p <0.05). There was no significant correlation between foramen morphometry on the affected side and patient age or sex. The foramen height on the affected side was a mean of 2 mm greater in women than in men (p <0.05).
Conclusion: This study determined anatomical parameters of the foramen ovale that are associated with a favourable intraoperative course in CBCT PBC. Specifically, a larger entry zone at the outer skull base is associated with a shorter operative duration.
