Use of a Laryngeal Mask Airway Decreases Radiation Exposure During Computed Tomography–Guided Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia

Abstract

We have been using computed tomography (CT) guidance for percutaneous glycerol rhizotomy (PGR) for the last 7 years. As a quality improvement exercise, we recently began using general anesthesia (GA) with the use of a laryngeal mask airway (LMA) because of our perception that the procedure went faster and that there was less radiation exposure because of less patient movement. We aim to compare PGR radiation exposure and procedural time between patients receiving local anesthetic with sedation and those receiving GA/LMA. A single-center historical cohort study was performed using patients treated with PGR between 2017 and 2019. Ninety-two surgeries were conducted during the study period: 64 surgeries had local anesthetic with intravenous sedation, and 28 surgeries had deeper anesthetic with LMA. Data analyzed included the number of CT sequences obtained, needle placement time, and total radiation dose. Use of GA/LMA resulted in a 23% decrease in mean radiation dose (565.5 vs. 436.1 μGy× cm, P= 0.014), number of CT sequences required (7.4 vs. 5.7, P= 0.003), and needle placement time (12.8 vs. 9.8 minutes, P= 0.006). Additionally, 10 patients underwent multiple glycerol rhizotomies during the collection period with both anesthetic types being used at least once. Seven of 10 patients (70.0%) had a reduction in total radiation dose, number of CT sequences obtained, and needle placement time when GA/LMA was used. There were no procedure- or anesthetic-related complications in this patient cohort. The use of GA/LMA during PGR is associated with decreased radiation exposure without increased anesthetic complications.