Application of stereotactic approach combined with 3D CT reconstruction in radiofrequency thermocoagulation of the trigeminal gasserian ganglion

Abstract

Objective To explore the role of stereotactic approach combined with surgical plan made by preoperative three-dimensional computed tomographic (3D CT) reconstruction in treatment of trigeminal neuralgia by percutaneous radiofrequency thermocoagulation of Gasserian Ganglion. Methods A retrospective analysis was conducted on 30 patients of trigeminal neuralgia who underwent percutaneous radiofrequency thermocoagulation of Gasserian Ganglion at Department of Neurosurgery, China-Japan Union Hospital of Jilin University, from May 2012 to March 2016. Stereotactic frame was installed and 3D CT reconstruction image was made prior to surgery. Image processing software (Vitrea fX, Version 6.6.2) was used to analyze difficult factors and make surgical plan. Results Foramen ovale puncture was successfully performed in all 30 patients. In the 11 cases with less than 2 difficult factors, an average of (1.4±0.7, range: 1-3) punctures were performed. In the remaining 19 cases with at least 2 difficult factors, an average of (2.6±0.9, range: 1-5) punctures were performed. All cases without bended puncture needles intraoperatively confirmed by fluoroscopy required only 1 puncture. No severe surgical complication occurred. The short-term and 1-year effective rates were 100% and 96.7% (29/30), respectively. Four cases reported recurrence at 2-year follow-up with the recurrence rate of 14.3% (4/28), and the 2-year effective rate was 85.7% (24/28). Conclusion Percutaneous radiofrequency thermocoagulation of Gasserian Ganglion using surgical plan made by stereotactic approach combined with preoperative three-dimensional computed tomographic (3D CT) reconstruction could provide accurate localization, which seems to be safe and effective, particularly for cases with difficult-to-puncture foramen ovale. Key words: Trigeminal neuralgia; Foramen oval; Stereotactic techniques; Radiofrequency thermocoagulation; Computed tomographic reconstruction