Workspace Analysis of Robotically Assisted Percutaneous Radiofrequency Thermocoagulation for the Trigeminal Neuralgia

Abstract Objective The purpose of this study is to evaluate the effectiveness and safety of percutaneous radiofrequency thermocoagulation (PRT) via the foramen rotundum (FR) for the treatment of isolated maxillary (V2) idiopathic trigeminal neuralgia (ITN) and assess the appropriate puncture angle through the anterior coronoid process to reach the FR. Methods Between January 2011 and October 2016, 87 patients with V2 ITN refractory to conservative treatment were treated by computed tomography (CT)–guided PRT via the FR at our institution. The outcome of pain relief was assessed by the visual analog scale (VAS) and Barrow Neurological Institute (BNI) pain grade and grouped as complete pain relief (BNI grades I–III) or unsuccessful pain relief (BNI grades IV–V). Recurrence and complications were also monitored and recorded. The puncture angle for this novel approach was assessed based on intraoperative CT images. Results Of the 87 treated patients, 85 (97.7%) achieved complete pain relief, and two patients (2.3%) experienced unsuccessful pain relief immediately after operation. During the mean follow-up period of 44.3 months, 15 patients (17.2%) experienced recurring pain. No severe complications occurred, except for hypoesthesia restricted to the V2 distribution in all patients (100%) and facial hematoma in 10 patients (11.5%). The mean puncture angle to reach the FR was 33.6° ± 5.7° toward the sagittal plane. Discussion CT-guided PRT via the FR for refractory isolated V2 ITN is effective and safe and could be a rational therapy for patients with V2 ITN.

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Unconventional Facial Entry Points Confirmed Using a 3D CT Reconstruction–Guided Stereotactic Approach to Radiofrequency Thermocoagulation for the Treatment of Trigeminal Neuralgia: A Series of Case Reports

Pain Medicine ◽

10.1093/pm/pny262 ◽

2018 ◽

Vol 20 (8) ◽

pp. 1551-1558 ◽

Cited By ~ 2

Author(s):

Zhigang Guo ◽

Zhijia Wang ◽

Kai Li ◽

Chao Du ◽

Xingli Zhao ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Anatomical Variation ◽

Preoperative Imaging ◽

Gasserian Ganglion ◽

Ct Reconstruction ◽

Foramen Ovale ◽

Radiofrequency Thermocoagulation ◽

Patient Reported ◽

Entry Points

Abstract Objectives Patients with trigeminal neuralgia who are refractory to medical therapy may choose to undergo Gasserian ganglion percutaneous radiofrequency thermocoagulation. However, in cases where the foramen ovale is difficult to access due to various anatomical anomalies, the typical estimation of the facial entry point is suboptimal. Methods Three-dimensional computed tomography reconstruction imaging performed before surgery revealed anatomical variations in each of the four adult patient cases that made it more difficult to successfully access the foramen ovale (FO) for percutaneous radiofrequency thermocoagulation. Using measurements collected from preoperative imaging that showed each specific anatomical variation in the FO, researchers marked alternate facial entry points that would allow successful probe placement into the FO and recorded the arc angle data in the stereotactic instrument. Results Patients were evaluated during follow-up visits ranging from seven to 26 months after surgery and asked to rate postoperative pain using a visual analog scale. These scores decreased from 10 to 3 in all four patients by the third day after the procedure. There were no permanent complications or morbidities from the surgery. One patient experienced mild facial numbness; however, this side effect subsided within three months after surgery. During the follow-up period, no patient reported pain recurrence. Conclusions The expectation for clinicians approaching trigeminal nerve block using a peri-oral approach should be to expect a great degree of potential variability in terms of both distances from the corner of the mouth and needle angle taken to successfully navigate the anatomy and access the foramen ovale.

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Factors Predicting Successful Outcomes for Percutaneous Radiofrequency Thermocoagulation in Patients With Idiopathic Trigeminal Neuralgia: Implications for Surgical Decision Making

Pain Practice ◽

10.1111/papr.12769 ◽

2019 ◽

Vol 19 (5) ◽

pp. 491-499 ◽

Cited By ~ 5

Author(s):

Xiuhua Li ◽

Shuyue Zheng ◽

Liqiang Yang ◽

Zhao Cao ◽

Jiaxiang Ni ◽

...

Keyword(s):

Decision Making ◽

Trigeminal Neuralgia ◽

Surgical Decision ◽

Radiofrequency Thermocoagulation ◽

Idiopathic Trigeminal Neuralgia ◽

Successful Outcomes ◽

Surgical Decision Making

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Computer-Assisted Design Template Guided Percutaneous Radiofrequency Thermocoagulation through Foramen Rotundum for Treatment of Isolated V2 Trigeminal Neuralgia: A Retrospective Case-Control Study

Pain Research and Management ◽

10.1155/2019/9784020 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ran Wang ◽

Ying Han ◽

Lijuan Lu

Keyword(s):

Trigeminal Neuralgia ◽

Control Group ◽

Computer Assisted ◽

Retrospective Case ◽

Ct Guided ◽

Computer Assisted Design ◽

Radiofrequency Thermocoagulation ◽

Significant Difference ◽

Foramen Rotundum ◽

Experimental Group

Objective. Radiofrequency thermocoagulation (RFT) through the foramen rotundum has emerged as an alternative for treatment of isolated V2 trigeminal neuralgia. But puncture of the foramen rotundum is difficult and time-consuming. In current study, we introduced the application of a computer-assisted design (CAD) template to guide foramen rotundum cannulation. Meanwhile, we assessed its safety and efficacy in the treatment of isolated V2 trigeminal neuralgia. Methods. From November 2015 to August 2017, thirty-eight patients with isolated V2 trigeminal neuralgia were treated with computed tomography- (CT-) guided RFT through the foramen rotundum in our institution. All cases were reviewed, and patients were divided into the experimental group (n=17, puncture with a CAD template) and control group (n=21, free-hand puncture) according to the puncture method used. The puncture times, duration of puncture, and duration of operation were collected. The outcome of pain remission was evaluated utilizing the Barrow Neurological Institute’s (BNI) pain score. Complications and recurrence of pain were also recorded. Data were compared between groups. Results. The rate of one-time successful puncture in the experimental group was obviously higher than that in the control group. Mean puncture times in the experimental group was fewer. Average duration of puncture and operation in the experimental group was also shorter than that in the control group. All patients experienced good pain remission (BNI Class I or II) postoperatively. At four follow-up points (7 days, 3 months, 6 months, and 12 months after operation), there was no significant difference in good pain relief rate between the two groups. Meanwhile, no significant difference was found in complications. Conclusions. CAD template is a safe and precise navigation instrument for RFT treatment of isolated V2 trigeminal neuralgia via the foramen rotundum. Therefore, this novel tool is worthy of clinical promotion.

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