Percutaneous Microcompression Research Articles

Enhancing Visualization of the Foramen Ovale in Percutaneous Microcompression: A Preoperative Image Simulation Technique

Introducing a preoperative image simulation technique to streamline the visualization of the foramen ovale in percutaneous microcompression. Twenty-five trigeminal neuralgia patients were included in the study. Preoperative cranial computed tomography scans were processed with 3D Slicer software to create simulated fluoroscopic skulls. The angulations required for precise visualization of the foramen ovale were established via simulated anteroposterior imaging. These simulations informed the C-arm's angulations for foramen ovale targeting during surgery. The preoperative simulations accurately forecasted skull rotation angulations, aligning closely with intraoperative observations with negligible discrepancies (0-2 degrees). In 17 patients, the foramen ovale was distinctly visible, while in 8 patients, it was partially obscured yet discernible using the simulated angles. Nonvisible of the foramen ovale did not occur. Postoperative pain relief and complications were recorded. Based on our initial findings, the application of preoperative image simulation shows significant referential value in achieving accurate visualization of the foramen ovale in percutaneous microcompression for trigeminal neuralgia.

Predicting balloon shape in percutaneous microcompression : an observational comparative analysis of Meckel's cave imaging and balloon morphology.

Achieving a pear-shaped balloon holds pivotal significance in the context of successful percutaneous microcompression procedures for trigeminal neuralgia. However, inflated balloons may assume various configurations, whether it is inserted into Meckel's cave or not. The absence of an objective evaluation metric has become apparent. To investigate the relationship between the morphology of Meckel's Cave and the balloon used in percutaneous microcompression for trigeminal neuralgia and establish objective criteria for assessing balloon shape in percutaneous microcompression procedures. This retrospective study included 58 consecutive patients with primary trigeminal neuralgia. Data included demographic, clinical outcomes, and morphological features of Meckel's cave and the balloon obtained from MRI and Dyna-CT imaging. MRI of Meckel's cave and Dyna-CT of intraoperative balloon were modeled, and the morphological characteristics and correlation were analyzed. The reconstructed balloon presented a fuller morphology expanding outward and upward on the basis of Meckel's cave. The projected area of balloon was strongly positively correlated with the projected area of Meckel's cave. The Pearson correlation coefficients were 0.812 (P<0.001) for axial view, 0.898 (P<0.001) for sagittal view and 0.813 (P<0.001) for coronal view. Similarity analysis showed that the sagittal projection image of Meckel's cave and that of the balloon had good similarity. This study reveals that the balloon in percutaneous microcompression essentially represents an expanded morphology of Meckel's cave, extending outward and upward. There is a strong positive correlation between the volume and projected area of the balloon and that of Meckel's cave. Notably, the sagittal projection image of Meckel's cave serves as a reliable predictor of the intraoperative balloon shape. This method has a certain generalizability and can help providing objective criteria for judging balloon shape during percutaneous microcompression procedures.

Letter: A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion.

Letter: A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion.

Chinese expert consensus on minimally invasive interventional treatment of trigeminal neuralgia.

Background and purposeTrigeminal neuralgia is a common condition that is associated with severe pain, which seriously affects the quality of life of patients. When the efficacy of drugs is not satisfactory or adverse drug reactions cannot be tolerated, minimally invasive interventional therapy has become an important treatment because of its simple operation, low risk, high repeatability and low cost. In recent years, minimally invasive interventional treatments, such as radiofrequency thermocoagulation (RF) of the trigeminal nerve and percutaneous microcompression (PMC), have been widely used in the clinic to relieve severe pain in many patients, however, some related problems remain to be addressed. The Pain Association of the Chinese Medical Association organizes and compiles the consensus of Chinese experts to standardize the development of minimally invasive interventional treatment of trigeminal neuralgia to provide a basis for its clinical promotion and application.Materials and methodsThe Pain Association of the Chinese Medical Association organizes the Chinese experts to compile a consensus. With reference to the evidence-based medicine (OCEBM) system and the actual situation of the profession, the Consensus Development Committee adopts the nominal group method to adjust the recommended level.ResultsPrecise imaging positioning and guidance are the keys to ensuring the efficacy and safety of the procedures. RF and PMC are the most widely performed and effective treatments among minimally invasive interventional treatments for trigeminal neuralgia.ConclusionsThe pain degree of trigeminal neuralgia is severe, and a variety of minimally invasive intervention methods can effectively improve symptoms. Radiofrequency and percutaneous microcompression may be the first choice for minimally invasive interventional therapy.

A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion.

The classic puncture method of percutaneous microcompression using fluoroscopy might be difficult to precisely locate and visualize the foramen ovale. Various new surgical tools to increase the accuracy of finding the foramen ovale location have been introduced. However, all of these systems require some complicated operating steps and/or advanced devices to complete the work. To describe the use of a simple method for foramen ovale puncture by percutaneous microcompression based on preoperative image simulation. Forty-five patients were included in the study. All patients underwent a computed tomography examination. Among them, the simulated preoperative puncture pathway was reconstructed on the basis of computed tomography scan examination for 22 patients. Procedures were performed by 2 surgeons: one experienced surgeon and another young surgeon with surgical qualification. The puncturing time and cumulative radiation exposure dose, from start of the puncturing until reaching the foramen ovale, were recorded. Postoperative pain relief, facial hypoesthesia, masticatory muscle weakness, and other complications were recorded. In all cases, the procedure of cannulation was completed successfully. The puncturing time for both the experienced and young surgeon with the use of preoperative image simulation seemed to be time-saving. The young surgeon had less cumulative radiation exposure with the use of preoperative image simulation. Moreover, the intraoperative puncture pathways were almost consistent with the preoperative simulated images. The rest of the process went smoothly. Short-term outcomes of all the 45 patients were satisfactory. Based on our preliminary experience, the preoperative image simulation-guided technique is useful during these cases.

Microsurgical posterior fossa exploration for trigeminal neuralgia: a study on 48 cases.

The authors present their experience in the microsurgical treatment of trigeminal neuralgia (TGN). Over the last five years 48 patients were explored and 34 (71 %) underwent microvascular decompression (MVD) for significant arterial or venous conflicts. The remaining 14 patients (29 %) underwent partial sensory rhizotomy (PSR) because of negative intraoperative findings (simple contact or no conflict). Excellent or good immediate outcomes were achieved in 87.5 and 12.5 % of patients, respectively. Of the three severe recurrences observed during the follow-up period (24.7 months; range: 7 - 65 months), two underwent percutaneous microcompression and one posterior fossa reexploration, which revealed teflon-induced recompression. None of the PSR cases experienced incapacitating face numbness. MVD, an extremely effective procedure in the immediate post-operative period, is burdened in the long term by 20 % recurrences, the majority occurring within two years from surgery. We believe that careful intraoperative evaluation of the conflict entity could be the key to achieve a significant reduction of recurrences: overestimation of simple vascular contact of doubtful etiologic relevance, may lead to ineffective decompression and unsatisfactory results. In our opinion PSR should be preferred to percutaneous treatments in cases of negative exploration (contact or no conflict). In accordance with others we observed that section of half or less of the inferolateral "portio major" allows long-lasting pain relief and good preservation of sensory function.

Percutaneous microcompression of the trigeminal ganglion for elderly patients with trigeminal neuralgia and patients with atypical trigeminal neuralgia.

Percutaneous microcompression of the trigeminal ganglion (PMTG) was performed in nine elderly patients (> 70 years) with trigeminal neuralgia and six patients with atypical neuralgia under short-acting anesthesia using propofol. Two patients had postherpetic neuralgia and two had postoperative neuralgia following removal of a posterior fossa neurinoma. Four patients had recurrent neuralgia following microvascular decompression (MVD). PMTG provided complete relief in 10 patients and the other five patients reported at least 50% improvement. No major complications occurred. PMTG is effective for typical trigeminal neuralgia in elderly patients, patients with atypical trigeminal neuralgia, and patients with recurrence after MVD.

Analysis of Ballon Volumes Used during Percutaneous Microcompression of the Gasserian Ganglion for Trigeminal Neuralgia in Korean Patients

Analysis of Ballon Volumes Used during Percutaneous Microcompression of the Gasserian Ganglion for Trigeminal Neuralgia in Korean Patients

Valoración de la técnica de Mullan en el tratamiento de la neuralgia del trigémino

The aim of the present study is to examine the operative technique and results of the treatment of trigeminal neuralgia (TN) by percutaneous microcompression of the trigeminal ganglion (Mullan's technique) in 20 consecutive patients over 3 years. The average age of the patients was 63 years. There were 8 men and 12 women. The operative technique is similar to Mullan and Lichtor's original description with some modifications. On average it takes 30 minutes to complete the procedure. On 2 occasions the catheter had to be replaced as the balloon burst without clinical repercussions. Detectable changes were noted in systemic blood pressure and cardiac rhythm in 10 cases. On 17 occasions the radiographic appearance of the balloon was pear-shaped and in the remaining cases it was oval or irregular. Follow-up ranged from 6 months to 3 years. All but 1 patient were initially relieved of pain and it was progressively possible to suspend treatment with carbamazepine. The recurrence rate was 25%. Mean time until recurrence was 18 months. There was no relation between pain location and recurrence. Morbidity: some degree of transient cheek discomfort, herpes simplex perioralis, hypesthesia and masseter weakness were the rule. Meningitis in one case. Early results indicate that Mullan's technique provides a reliable, safe, cheap and effective, with low morbidity and no mortality.

Effect of Percutaneous Microcompression in Trigeminal Neuralgia: Case report

Effect of Percutaneous Microcompression in Trigeminal Neuralgia: Case report

Pressure Monitoring inside Meckel's Cave during Percutaneous Microcompression of Gasserian Ganglion

During percutaneous microcompression of the gasserian ganglion for the relief of trigeminal neuralgia, a computerized technique for monitoring the pressure inside Meckel's cave was employed in 22 patients. A dedicated transducer connected to a computer records the balloon inflation pressure. Its variations are discernible within tenths of a bar and are plotted in relation to time. The intraoperative pressure inside Meckel's cave is from 0.9 to 2.4 bars. When pressure was low, there was recurrence of pain. The highest values of pressure (1.9-2.4 bars) were observed in most of the patients suffering from untoward side effects. The clinical results seem to be influenced by the level of the intraoperative intracavitary pressure.

Trigeminal Evoked Potentials in Patients Undergoing Percutaneous Microcompression of Gasserian Ganglion

22 patients undergoing percutaneous microcompression of Gasserian ganglion for the treatment of trigeminal neuralgia were monitored intraoperatively by means of trigeminal evoked potentials (TEPs). The second trigeminal branch was stimulated at the maxillary foramen; evoked responses were recorded using subcutaneous electrodes placed over the scalp. TEPs presented several short-latency waves (called W1, W2, W3, P4, N5, P6, N10) which are generated before and after the ganglion (W1, W2, W3), in the brain stem (P4, N5, P6) and possibly in the cortex (N10); other waves occur within 150 ms after the stimulus (late waves). During compression, W1 did not change, while W2 and W3 as well as P4, N5, P6, N10 and late waves decreased in amplitude: this pattern was noted in the patients who presented with pain relief during the follow-up period. On the contrary, the patients who suffered from pain recurrence did not show similar intraoperative TEP changes. In conclusion, intraoperative TEP derangements may be related to the effectiveness of the compression on the Gasserian ganglion.

Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia

The authors report 144 cases of trigeminal neuralgia treated by percutaneous microcompression of the trigeminal ganglion (PMTG). The operation was performed under short-lasting barbiturate anesthesia without endotracheal intubation. Meckel's cave was cannulated with a No. 4 Fogarty catheter and the balloon was inflated for 1 minute. The average intraluminal pressure required for adequate compression of the ganglion was about 1200 mm Hg. All patients were initially relieved of their neuralgia. In a follow-up period ranging from 6 months to 4 1/2 years, 14 patients (9.7%) developed recurrence of pain between 10 and 35 months after surgery. Eleven patients underwent a second PMTG. All nine early failures and 10 of the 11 late recurrences occurred in cases with technical deficiencies. Most of the minor surgical complications observed were also related to avoidable technical errors. There were no anesthetic complications and no deaths. All patients developed mild to moderate postoperative hemifacial numbness with or without objective hypesthesia. Both subjective and objective deficits gradually diminished with time and were well tolerated. One year after the operation nearly 40% of the patients still had patches of slightly decreased sensation in one or more trigeminal divisions and 16% had mild dysesthesia. Anesthesia dolorosa or keratitis was not reported. The PMTG procedure is easy to perform and requires a short operative time and a brief period of hospitalization. It is well tolerated by patients, who describe it as a totally pain-free experience. Morbidity is minimal and recurrence of neuralgia does not seem to be higher than with alternative procedures.

Microvascular Decompression versus Percutaneous Procedures for Typical Trigeminal Neuralgia: Personal Experience

This study includes 127 patients treated for typical trigeminal neuralgia, 74 of whom underwent a percutaneous microcompression (PMC), 33 a radiofrequency thermocoagulation (RFT) and 20 were explored for microvascular decompression (MVD). A mean follow-up of 24 months was reached by all the groups. Pain relief was evaluated as an 'all or none' effect. At hospital discharge, pain had disappeared in 93.2% of the patients treated with PMC, in 81.8% of those treated with RFT, and in 85% of the MVD group. At 24 months the effect was maintained by 57.2% of the PMC group, 57.6% of the RFT, and by 75% of the MVD group. Marked dysesthesia was reported by 6.7% of the patients treated with PMC, and by 24.2% of those who received a RFT. Impairment of masticatory function was observed in 10% of the PMC patients. Ipsilateral hypoacusia and transient IV nerve palsy in 1 patient was the only major complication after MVD.

A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion

Percutaneous microcompression of the trigeminal ganglion for the relief of trigeminal neuralgia is a technically simple, nonpainful procedure, carried out under brief general anesthesia. One hundred patients treated by this method have been followed for 1 to 10 years; treatment has been technically successful in 97% of cases. Relief persisted at five years in 80%, and it is estimated that at 10 years the figure will be 70%. There were no deaths, no cerebral damage, no keratitis, and no analgesia dolorosa; 4% of the patients reported dysesthesia.

Percutaneous surgical treatment of trigeminal neuralgia.

The authors report on indications and results of percutaneous surgical treatment of trigeminal neuralgia based on own experiences in 1124 cases. In 912 cases percutaneous thermorhizotomy and in 212 cases percutaneous microcompression have been used. As a conclusion the following considerations have been stressed: I) In both methods slight hypaesthesia appears to obtain good pain relief; II) Percutaneous thermorhizotomy is indicated in third division neuralgias; III) Percutaneous microcompression is indicated for first and second division neuralgias only when the trigeminal cistern is not abnormally dilated; IV) Undesirable side-effects after either thermorhizotomy and microcompression are similar and transitory in most cases; V) Pain recurrence for both procedures are comparable and range at about 25%.

Percutaneous procedures for trigeminal neuralgia: Microcompression versus radiofrequency thermocoagulation. Personal experience

This paper reports the results achieved in the treatment of trigeminal neuralgia using two different percutaneous procedures: radiofrequency (RF) thermocoagulation (33 patients) and the new percutaneous microcompression (PMC; 74 patients) of the trigeminal ganglion. Acute pain relief was accomplished in 93.2% of the patients treated with PMC and in 81.8% of those treated with the RF method. Two years after the operation, neuralgia had recurred in 56% of the PMC patients and in 42.4% of the RF patients. The average recurrence time was 6.5 months after PMC and 18.5 months after RF. Side effects were essentially of 2 kinds: marked dysaesthesia that occurred after RF lesion in 24.2% and after PMC in 6.7% of the patients, and weakness of the masticatory muscles that was fairly common after PMC, although clinically relevant in only 1 case. The procedure has the benefit of simplicity and fewer side effects. The results obtained by using different compression times in different patients indicates that the most suitable compression time is between 4 and 6 min. When pain recurred the procedure was repeated unless the pain was in the third division, in which case an RF lesion was made. If the pain recurred a second time, RF lesions were made if the pain was in the second or third division.

Trigeminal depressor response during percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia

Trigeminal depressor response during percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia

Trigeminal depressor response during percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia.

Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia was performed 23 times on 21 patients. Significant abrupt drops in heart rate and blood pressure (P less than 0.0002) occurred when the needle entered the foramen ovale or upon balloon advancement or inflation. In 16 of 23 (70%) procedures, the heart rate fell abruptly to 60 or less, by a mean of 38%. Mean arterial blood pressure decreased transiently by 31% during 12 of 23 (55%) procedures. Our findings of transient bradycardia and hypotension upon mechanical stimulation or compression of the mandibular nerve or trigeminal ganglion show for the first time the presence of a trigeminal depressor response in humans. We recommend that heart rate and arterial blood pressure be monitored continuously during percutaneous microcompression of the trigeminal ganglion. Intravenous atropine should be available for immediate use, and an external pacemaker should be fitted preoperatively.

Subarachnoid Hemorrhage and “Normal Pressure Hydrocephalus”: Fatal Complication of Percutaneous Microcompression of the Gasserian Ganglion

Subarachnoid Hemorrhage and “Normal Pressure Hydrocephalus”: Fatal Complication of Percutaneous Microcompression of the Gasserian Ganglion