Abstract
BackgroundPercutaneous radiofrequency trigeminal rhizotomy (RF-TR) is a well-established treatment for patients suffering from trigeminal neuralgia (TN) as a primary modality or for those refractory to medical treatment. However, few existing studies have identified intraoperative parameter or navigation technique that can be used to predict the rates of short-term or long-term pain relief. In this study, we analyzed patient characteristics, intraoperative parameters and technical factors, and postoperative changes in relation to immediate and long-term pain relief.MethodThis study included a total 252 patients in which 340 RF-TR were performed under the guidance of intraoperative computed tomography (iCT) alone or with magnetic resonance image (MRI) and iCT fusion imaging.ResultThe immediate pain relief of RF-TR with iCT alone and iCT with MR image guidance with or without cerebrospinal fluid (CSF) outflow were all above 90.4%. The 2-year pain relief rate of RF-TR using iCT alone and iCT with MR images guidance with or without CSF outflow were 47.8%, 39.8%, 71.7%, and 53.9% respectively. Significant factors for 2-year pain relief were CSF outflow, iCT with MR image fusion, non-recurrent TN, and presence of postoperative facial numbness.ConclusionThis preliminary study demonstrated foramen ovale cannulation under the aid of iCT with MR image guidance could improve 2-year pain relief.
Highlights
Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) is a well-established and effective technique for treating trigeminal neuralgia (TN) [25]
RF-TR with intraoperative computed tomography navigation became the treatment of choice in our center since August 2010, which progressed further to include fusion images of computed tomography and magnetic resonance image (MRI); this progression was based on the fact that prior image guidance techniques only allowed the accurate cannulation of the foramen ovale, whereas the inclusion of MRI enabled visualization of the trigeminal cistern and ganglion, which we hypothesize could facilitate better anatomical localization of the target for lesioning
We assessed the efficacy of RF-TR under the guidance of MRI and intraoperative computed tomography (iCT) fusion imaging and explored factors that are associated with long-term outcome and complications
Summary
Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) is a well-established and effective technique for treating trigeminal neuralgia (TN) [25]. We assessed the efficacy of RF-TR under the guidance of MRI and iCT fusion imaging and explored factors that are associated with long-term outcome and complications. Few existing studies have identified intraoperative parameter or navigation technique that can be used to predict the rates of short-term or long-term pain relief. We analyzed patient characteristics, intraoperative parameters and technical factors, and postoperative changes in relation to immediate and long-term pain relief. The 2-year pain relief rate of RF-TR using iCT alone and iCT with MR images guidance with or without CSF outflow were 47.8%, 39.8%, 71.7%, and 53.9% respectively. Significant factors for 2-year pain relief were CSF outflow, iCT with MR image fusion, non-recurrent TN, and presence of postoperative facial numbness
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