Work

Intraoperative computed tomography-guided neuronavigation for radiofrequency rhizotomy in trigeminal neuralgia: optimizing cannulation trajectories for individual anatomy

Year: 2025

Type: article

Abstract: OBJECTIVE: Fluoroscopy-guided radiofrequency rhizotomy for trigeminal neuralgia relies on biplanar fluoroscopic imaging and surface landmarks. However, anatomical variations and imaging limitations often necessitate multiple attempts, leading to patient discomfort and increased procedural risks. This study evaluated the procedural outcomes of radiofrequency rhizotomy using preplanned trajectories and intraoperative computed tomography with neuronavigation. DESIGN: Retrospective study. SETTING: Single-center study conducted in a neurosurgical department. PARTICIPANTS: Forty-six patients with trigeminal neuralgia who underwent radiofrequency rhizotomy between September 2019 and December 2024 were recruited in this study. INTERVENTION: Cannulation of the foramen ovale was performed using navigation-guided trajectories, with intraoperative computed tomography used to adjust the trajectory if initial attempts failed. Success rates and the distances between the landmark-based and neuronavigation-guided entry points were measured. RESULTS: Among the 46 procedures, the entry points were adjusted from the landmark-based entry points in 22 patients (47.8%) to achieve successful foramen ovale cannulation. Adjustments involved inferolateral displacement in 17 cases and inferomedial displacement in 5 cases. The mean lateral displacement was 3.75 ± 5.40 mm, and the mean inferior displacement was 14.65 ± 6.91 mm. Foramen ovale cannulation was successfully achieved in all the patients without complications. CONCLUSIONS: Intraoperative computed tomography and navigation-guided radiofrequency rhizotomy are safe and effective techniques for treating trigeminal neuralgia. The conventional entry point designated by surface landmarks was not optimal in 47.8% cases, who required an inferior shift to accommodate anatomical variations.

Source: Pain Medicine

DOI: 10.1093/pm/pnaf060

Authors: Junhyung Kim, Jung Woo Yu, Jinu Rim, Won Seok Chang, Hyun Ho Jung

Institutions: Yonsei University, Yonsei University Health System

Language: English

Topic: Trigeminal Neuralgia and Treatments

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $5,036