scholarly journals Bi-Plane Fluoroscopic-Guided Balloon Rhizotomy for Trigeminal Neuralgia: A Technical Note

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Awais Vance ◽  
Tarek Youssef El Ahmadieh ◽  
Zachary Christian ◽  
Salah G Aoun ◽  
Samuel L Barnett ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Technical Note ◽  
Percutaneous Technique ◽  
Foramen Ovale ◽  
Mandibular Ramus ◽  
Anatomical Structures ◽  
Percutaneous Balloon ◽  
A New Technique ◽  
Multiple Patients ◽  
Orbital Rim

Abstract INTRODUCTION The classic partially blinded percutaneous technique using external landmarks to cannulate the foramen ovale for the treatment of trigeminal neuralgia can place important anatomical structures, such as the distal cervical internal carotid artery, at risk. We have developed a new technique in which we use anteroposterior fluoroscopy to reliably locate the foramen ovale and thus make it safer and easier to cannulate. METHODS Locating foramen ovale was initially tested using anteroposterior fluoroscopy on cadaveric skulls in the neurosurgical simulation lab. Fluoroscopic landmarks were identified and utilized to assist in successfully locating the foramen ovale during percutaneous balloon rhizotomy procedures performed in multiple patients with trigeminal neuralgia. This technique was successfully used in multiple patients at our institution without any immediate complications except for one cheek hematoma. In this report, we describe our technique in detail. RESULTS The AP fluoroscopy is directed laterally in the coronal plane until a line drawn inferiorly from the lateral orbital rim bisects the inner concavity of the mandibular angle. Fluoroscopy is then directed inferiorly until the top of the petrous ridge bisects the mandibular ramus. The foramen ovale will come into view within the window between the mandibular ramus and hard palate. Two case illustrations are provided CONCLUSION Balloon rhizotomy is a commonly used treatment option for trigeminal neuralgia. Direct visualization of the foramen ovale can reliably be achieved on AP fluoroscopy using specific anatomic landmarks. This technique can be utilized to increase the accuracy and safety of the procedure.

scholarly journals Minimizing Technical Failure of Percutaneous Balloon Compression for Trigeminal Neuralgia Using Neuronavigation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Miltiadis Georgiopoulos ◽  
John Ellul ◽  
Elisabeth Chroni ◽  
Constantine Constantoyannis
Keyword(s):  
Trigeminal Neuralgia ◽  
Navigation System ◽  
Technical Failure ◽  
Foramen Ovale ◽  
Successful Cannulation ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Safe Management ◽  
Percutaneous Balloon Compression ◽  
Head Computed Tomography

Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient’s forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.

Factors That Influence Outcome of Percutaneous Balloon Compression in the Treatment of Trigeminal Neuralgia

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 925-934 ◽  
Author(s):  
Konstantinos Kouzounias ◽  
Gastón Schechtmann ◽  
Göran Lind ◽  
Jaleh Winter ◽  
Bengt Linderoth
Keyword(s):  
Trigeminal Neuralgia ◽  
Complication Rate ◽  
Statistical Significance ◽  
Therapeutic Modality ◽  
Percutaneous Technique ◽  
Strong Impact ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Compression Time ◽  
Percutaneous Balloon Compression

Abstract BACKGROUND: Percutaneous balloon compression is an effective, low-cost, simple therapeutic modality with the special advantage of being the only percutaneous technique that can be simply performed with the patient under general anesthesia for the treatment of trigeminal neuralgia. OBJECTIVE: To identify surgical and individual parameters that could influence outcome in patients with trigeminal neuralgia treated with percutaneous balloon compression. METHODS: Within a 5-year period, 66 consecutive percutaneous balloon compressions were performed in 47 patients. The medical and surgical records of all patients were retrospectively reviewed and analyzed for a possible correlation between the following parameters and outcome: balloon shape, balloon volume, compression time, age, sex, type of pain, duration of disease, previous procedures, and trigeminal division affected. Univariate and multivariate analyses were used to test for statistical significance. RESULTS: The initial success rate was 85%, and 36% of the responders are still pain free with a mean follow-up of approximately 20 months, whereas in 33 patients, trigeminal pain recurred after a mean of approximately 17 months. Of the investigated parameters, significant correlations were obtained between balloon shape and all aspects of outcome, previous operations and complication rate, pain type and complication rate, and compression time and postoperative numbness. CONCLUSION: The balloon shape is a parameter with a very strong impact on outcome, and balloon volume should be adjusted to this parameter. Persistent elliptical balloon shapes should raise consideration of aborting the procedure. There were no differences in outcomes between 60 seconds and longer compression times. The number of previous operations did not correlate with pain relief, but seemed to increase the risk of complications. Patients with multiple sclerosis seemed to obtain similar benefit from the procedure as do patients with classic trigeminal neuralgia.

scholarly journals Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia Using a Single-Plane, Flat Panel Detector Angiography System: Technical Note

2016 ◽  
Vol 56 (5) ◽  
pp. 257-263 ◽  
Author(s):  
Hidetaka ARISHIMA ◽  
Satoshi KAWAJIRI ◽  
Hiroshi ARAI ◽  
Yoshifumi HIGASHINO ◽  
Toshiaki KODERA ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Technical Note ◽  
Flat Panel ◽  
Single Plane ◽  
Flat Panel Detector

Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers

1974 ◽  
Vol 40 (2) ◽  
pp. 143-156 ◽  
Author(s):  
William H. Sweet ◽  
James G. Wepsic
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Electrical Heating ◽  
Gasserian Ganglion ◽  
Foramen Ovale ◽  
Content Type ◽  
Corneal Scarring ◽  
Radiofrequency Heating ◽  
Neurological Morbidity ◽  
Fine Print

✓ The authors report their experience in the treatment of trigeminal neuralgia with controlled increments of radiofrequency heating from an electrode placed in the Gasserian ganglion or its posterior rootlets. Touch is preserved in some or all of a trigeminal zone rendered analgesic. The electrode tip is introduced through the foramen ovale and placed among the desired rootlets with the help of a combination of radiographs and the conscious patient's response to electrical stimulation with a square wave signal and gentle electrical heating. The degree of heat is measured by a thermister at the electrode tip. The patient's cooperation is maintained by the use of the neurolept anesthetic Innovar and the production of brief unconsciousness for the painful parts of the operation by methohexital (Brevital). Of 274 patients with facial pain so treated, 214 had trigeminal neuralgia; 91% of the latter group experienced relief of pain and 125 followed for 2½ to 6 years had a recurrence rate of 22%. In a total of 353 procedures, there has been no mortality and no neurological morbidity outside the trigeminal nerve. Only six of the patients with trigeminal neuralgia have complained significantly of postoperative paresthesias. The most serious undesired result has been the production of an anesthetic cornea in 28 patients, one of whom lost the sight of one eye due to corneal scarring. Correlating findings in our patients with those in studies by other authors, we conclude that the preservation of some touch is due to resistance to heating by the heavily myelinated A-beta fibers.

scholarly journals A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

2011 ◽  
Vol 69 (2a) ◽  
pp. 221-226 ◽  
Author(s):  
Wuilker Knoner Campos ◽  
Marcelo N. Linhares
Keyword(s):  
Trigeminal Neuralgia ◽  
Female Gender ◽  
Safe Procedure ◽  
Approval Ratings ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Face ◽  
The Right ◽  
A Prospective Study

OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54%), the right side of the face (84%) and V2V3 roots of trigeminal nerve (33%). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80%) were pain-free after 50 months with a 90% satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

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