Three-dimensionally printed personalized guide plate for percutaneous radiofrequency thermal coagulation in idiopathic trigeminal neuralgia

A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia

OBJECTIVES

Radiofrequency thermocoagulation (RFT) is a type of Gasserian ganglion-level ablative intervention that is used for the treatment of trigeminal neuralgia. Guidance technologies are used to assist in the cannulation of the foramen ovale (FO) or foramen rotundum (FR) target. We conducted a systematic review to assess the value of different guidance technologies for RFT.

METHODS

We searched PubMed, Embase, the Cochrane database, Web of Science, and PROSPERO for studies published from January 2005 until December 2020. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and the nonrandomized studies of interventions-I tool were used to assess individual study characteristics and overall quality.

RESULTS

Our query identified 765 publications, and we were able to analyze 11 studies on patients suffering from trigeminal neuralgia. Only one study involved randomized controlled trials, whereas the others featured nonrandomized designs, predominantly before-and-after comparisons. Most of them were observational studies. A total of 222 participants were included, with a median number (range) of 20 (3-53) participants. The objective response rate (ORR) of the one-puncture success rate of RFT using puncture guidance for trigeminal neuralgia was 92% [95% CI (0.79-1), P < 0.001]. Statistically significant differences were observed in the cannulation and operation times between the guided and manual puncture groups (P < 0.001).

CONCLUSIONS

RFT with puncture guidance technology has an absolute advantage in puncturing the foramen ovale or foramen rotundum.

Xper-CT combined with laser-assisted navigation radiofrequency thermocoagulation in the treatment of trigeminal neuralgia

Objective

Our objective was to study the clinical feasibility of Xper-CT combined with laser-assisted radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.

Materials and methods

A retrospective analysis was made of 60 patients with trigeminal neuralgia who visited the Affiliated Hospital of Binzhou Medical University from January 2019 to May 2021. According to the different surgical methods, we were divided into C-arm X-ray group and laser navigation group. The operation time, operative complications, post-operative 24 h, post-operative 3 and 6 months Barrow Neurotics Institute (BNI) score were recorded and compared.

Results

Compared with the C-arm X-ray-guided puncture group, Xper-CT combined with laser-assisted navigation has the obvious advantages of shorter total puncture time, shorter surgical time, higher success rate of first puncture, and better surgical effect.

Conclusion

Radiofrequency therapy of trigeminal neuralgia with Xper-CT combined with laser-assisted navigation has a good clinical effect and can be promoted and applied.

Identifying a Novel Critical Access Difficulty Factor in Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia: Pterygoid Process Ridge

BACKGROUND

Percutaneous stereotactic radiofrequency rhizotomy (PSR) is an ablative procedure for trigeminal neuralgia (TN). The anatomic structures that pass through, or around, the foramen ovale (FO) play vital roles in the success rate of PSR. The presence of a variant pterygoid process ridge (PPR) obscuring the FO renders the cannulation procedure difficult but had not been described in the literature before.

OBJECTIVE

To identify the variations of the PPR to assess cannulation difficulty.

METHODS

Fifty seven FOs of 57 patients with TN (TN group) and 438 FOs of 232 patients without TN (non-TN group) were analyzed using 3-dimensional computed tomography reconstruction images of cranial bases. Three-dimensional printer models were also used for TN patients with PPR-obscured FOs. Measurements were obtained for shape, size, and morphometric variability effect on cannulation.

RESULTS

We identified 5 PPR-obscured FOs (8.8%) in the TN group and 32 FOs (7.3%) in the non-TN group. In the TN group, the transverse diameter obstruction ranged from 19.2% to 39.7% in 4 patients, and 1 case was 100%. Of particular note, approximately one-quarter to one-third of FO preset targets were affected by PPR.

CONCLUSION

A PPR-obscured FO represents a new confounding factor in the conduct of PSR. Confirming the PPR-obscured FO is a critical step in improving the effectiveness of puncture target presetting, ie, evaluating the target with actual FO data is an improvement over the use of surgical view FO data. Discernment of the PPR can improve the success rate of difficult-to-access FO punctures, thereby rendering PSR more effective.

Peroral Trigeminal Rhizotomy Using a Novel 3-Dimensional Printed Patient-Specific Guidance Tool

BACKGROUND

Ganglion Gasseri rhizotomy is a viable therapeutic option for trigeminal pain (TP). For this neurosurgical procedure, different potential operative and technical nuances exist.

OBJECTIVE

To evaluate a novel peroral trigeminal rhizotomy method and 3-dimensional printed patient-specific guidance tool (3D-PSGT) with respect to their applicability and safety.

METHODS

Between March 2018 and February 2021, 20 peroral balloon compression rhizotomy procedures with a 3D-PSGT were performed in 18 consecutive TP patients (13 female, mean age 58 yr). We registered the procedure duration, side effects, complications, and trigeminal function. The therapeutic effect was gauged from reduction of TP and use of analgesics.

RESULTS

All catheter insertions and rhizotomy procedures were successful at the first attempt. Apart from fluoroscopy, no auxiliary material was necessary. The average length of surgery was 19 min (range, 11-27 min). In total, 8 patients indicated complete analgesia and 6 patients pain relief; in 4 patients, persistence of TP was observed during follow-up examinations of up to 20 mo. In total, 6 patients reported of new mild to moderate facial hypesthesia affecting the trigeminal branches V2, V3, or V1-3. No masticatory musculature or corneal affections and device-related complications occurred.

CONCLUSION

The peroral 3D-PSGT trigeminal rhizotomy is straightforward for the neurosurgeon. This operative approach allows for rapid, safe, and simple foramen ovale cannulation in TP patients and reduces the use of additional equipment, radiation exposure, and procedure time.

Tooth-supported personalized template-assisted foramen ovale puncture system for trigeminal neuralgia treatment

PURPOSE

To introduce a tooth-supported personalized template-assisted foramen ovale (FO) puncture system for trigeminal neuralgia (TN) treatment, analyze its advantages, and review other previously reported methods.

METHODS

Sixty-seven patients were included. According to the preoperative digital design, the personalized puncture path was determined. Then, a tooth-supported personalized template was designed and manufactured. Finally, surgery (radiofrequency thermocoagulation or balloon compression) was carried out with the assistance of the template. The puncture effect and puncture-associated complications were evaluated, and the related literature was reviewed.

RESULTS

The FO was successfully punctured in one attempt in all patients. The procedure was completed in 15 s in 35 (52.24%) patients and in 15-30 s in 28 (41.79%) patients. The required position was accurately reached in all patients, and the center point error range was within 1 mm. No complications associated with puncture occurred.

CONCLUSION

The tooth-supported personalized template-assisted FO puncture system reported in this paper is an exceedingly simple, highly effective and safe FO puncture method that is worth popularizing.