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Gordon J, Piper K, George Z, Vakharia K, Bezchlibnyk YB, Van Loveren H. Anatomic Variations of Foramen Ovale as a Predictor of Successful Cannulation in Percutaneous Trigeminal Rhizotomies. Oper Neurosurg (Hagerstown) 2024; 26:279-285. [PMID: 38358285 DOI: 10.1227/ons.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous trigeminal rhizotomies are common treatment modalities for medically refractory trigeminal neuralgia (TN). Failure of these procedures is frequently due to surgical inability to cannulate the foramen ovale (FO) and is thought to be due to variations in anatomy. The purpose of this study is to characterize the relationships between anatomic features surrounding FO and investigate the association between anatomic morphology and successful cannulation of FO in patients undergoing percutaneous trigeminal rhizotomy. METHODS A retrospective analysis was conducted of all patients undergoing percutaneous trigeminal rhizotomy for TN at our academic center between January 1, 2010, and July 31, 2022. Preoperative 1-mm thin-cut computed tomography head imaging was accessed to perform measurements surrounding the FO, including inlet width, outlet width, interforaminal distance (a representation of the lateral extent of FO along the middle fossa), and sella-sphenoid angle (a representation of the coronal slope of FO). Mann-Whitney U tests assessed the difference in measurements for patients who succeeded and failed cannulation. RESULTS Among 37 patients who met inclusion criteria, 34 (91.9%) successfully underwent cannulation. Successful cannulation was associated with larger inlet widths (median = 5.87 vs 3.67 mm, U = 6.0, P = .006), larger outlet widths (median = 7.13 vs 5.10 mm, U = 14.0, P = .040), and smaller sella-sphenoid angles (median = 52.00° vs 111.00°, U = 0.0, P < .001). Interforaminal distances were not associated with the ability to cannulate FO surgically. CONCLUSION We have identified morphological characteristics associated with successful cannulation in percutaneous rhizotomies for TN. Preoperative imaging may optimize surgical technique and predict cannulation failure.
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Affiliation(s)
- Jonah Gordon
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Keaton Piper
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Zeegan George
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Harry Van Loveren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
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Zhang W, Zhao C, Shen Y, Xing Y, Luo F. Efficacy and safety of computed tomography-guided percutaneous balloon compression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia. Neurosurg Rev 2023; 46:112. [PMID: 37154844 DOI: 10.1007/s10143-023-02019-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/23/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
Percutaneous balloon compression (PBC) of Gasserian ganglion has been popularly used to treat trigeminal neuralgia (TN), one of the most painful syndromes in human experience. Vertebrobasilar dolichoectasia (VBD) is a rare cause of TN and remains challenging to treat. To our knowledge, no study has reported the therapeutic outcome of PBC for VBD-related TN (VBD-TN). In this retrospective study, we collected and analyzed the medical records of all patients undergoing PBC procedure for VBD-TN under the guidance of CT plus three-dimensional reconstruction at the Pain Management Center of Beijing Tiantan Hospital from January 2017 to December 2022. All 23 patients (15 men and 8 women) had a substantial pain relief as modified Barrow Neurological Institute (BNI) I-IIIb immediately after procedure. The follow-up duration ranged from 2 to 63 months, and at the last follow-up visit, only 3 patients (13%) relapsed (BNI IV-V). The cumulative recurrence-free survival was 95%, 87%, and 74% within 1, 3, and 5 years, respectively. Patients' reported satisfactory rate was 100% as Likert scale 4-5 throughout the whole follow-up period, with no severe complications occurring. Our data revealed promising efficacy and safety of PBC procedure for treatment of VBD-TN, thus suggesting a valuable option for pain control in these rare cases of TN. However, there has been no supporting evidence that PBC treatment is a preferred option to other treatments.
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Affiliation(s)
- Wei Zhang
- Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Chunmei Zhao
- Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Ying Shen
- Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Yan Xing
- Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China
| | - Fang Luo
- Department of Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People's Republic of China.
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Tan K, Li J, Peng Y, Wu W, Yang Z, Wang Y, Wang Y. Robot-Assisted Percutaneous Balloon Compression in Elderly Patients with Trigeminal Neuralgia. J Pain Res 2023; 16:1161-1168. [PMID: 37051267 PMCID: PMC10084829 DOI: 10.2147/jpr.s396680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Objective To investigate the clinical effects of percutaneous balloon compression (PBC) for trigeminal neuralgia in elderly patients with the assistance of a neurosurgical navigation and positioning planning system (referred to hereafter as the robot). Methods We performed a retrospective analysis of 11 patients with trigeminal neuralgia. Preoperative TOF MRA, T2WI-SPACE, and thin-slice CT scans were performed, and the volume of Meckel's Cave was calculated by multi-modal image fusion on a workstation. Surgical planning involved two paths. Path A was the actual puncture path, the target point was the anterior inner quadrant of the inner opening of the foramen ovale; Path B represented a virtual path for measurement, and was used to plan the depth of balloon placement. The foramen ovale puncture for path A was completed under the guidance of a robotic arm adapter, while path B was completed under lateral X-ray fluoroscopy with a DSA machine. The balloon was placed at a predetermined depth, and filled to a "pear" shape to complete the operation. Preliminary follow-up results were obtained by considering VAS score and BNI classification. Results The foramen ovale was successfully punctured in all 11 patients and entered Meckel's Cave, the balloon was then filled to create a "pear shape". Immediate complete healing was achieved in 10 patients and delayed healing was achieved in one patient by the 5th postoperative day. No serious complications were identified that were related to surgery, and over a follow-up time of 1-12 months, there was no recurrence of pain, and a BNI numbness grade of 2-3 points. The appropriate ratio of the balloon inflated volume to the preoperative Meckel's Cave volume was approximately 1.7. Conclusion Preliminary clinical application and short-term follow-up showed that robot-assisted PBC surgery is a safe and effective surgical method for elderly patients with trigeminal neuralgia.
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Affiliation(s)
- Ke Tan
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
- Correspondence: Ke Tan, Email
| | - Jinping Li
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yutao Peng
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Wenqian Wu
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Ziwen Yang
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yu Wang
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yang Wang
- Department of Neurosurgery, BeiJing ChaoYang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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Continuous Intra-Arterial Blood Pressure Monitoring Improves the Efficiency of Percutaneous Balloon Compression of the Trigeminal Ganglion for Trigeminal Neuralgia. Pain Res Manag 2022; 2022:7567630. [PMID: 36225719 PMCID: PMC9550456 DOI: 10.1155/2022/7567630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/20/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
Objective The aim of the study is to explore the characteristics of systolic blood pressure (SBP) and heart rate (HR) changes in patients undergoing percutaneous balloon compression (PBC) for trigeminal neuralgia and analyze the factors that influence the formation of the symbolic pear shape of the balloon, which signifies successful compression. Methods We retrospectively analyzed the changes in systolic blood pressure (SBP) and heart rate (HR) in 103 consecutive patients with trigeminal neuralgia (TN). Fifty-five patients who underwent operations with intermittent inflating cuff blood pressure (IICBP) monitoring were classified into the IICBP group. The other 48 patients who underwent continuous intra-arterial blood pressure (CIABP) monitoring were classified into the CIABP group. Results Among all the patients, there were more women than men and the patients in both the groups more commonly had TN on the right side and involving branch III. First, the balloon appeared as “pear-shaped” when the compression was effective, and the SBP increased an average of 59.04% in the CIABP group. CIABP provided us the precise range of the increase. Older patients had higher SBPs, especially patients with hypertension. Second, SBP was more sensitive and lasted much longer than HR in the process of puncturing the foramen ovale and compressing the ganglion. SBP fluctuated much more in the CIABP group than in the IICBP group. Third, the median time taken in the CIABP group was less than the IICBP group, and the prognosis of the CIABP group was better than the IICBP group. Conclusion Effective ganglion compression significantly increased SBP. CIABP can monitor SBP in real time and can also safeguard the compression process. CIABP is a safe and effective method in the PBC process that is worthy of promotion and application.
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Predictors of response for percutaneous balloon compression for the treatment of recurrent trigeminal neuralgia following surgical procedures: a retrospective study. Neurosurg Rev 2022; 45:3447-3455. [PMID: 36074278 DOI: 10.1007/s10143-022-01852-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/07/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
Recurrent trigeminal neuralgia (TN) after surgical procedures can be rather difficult to treat, and standardized treatment measures are not available yet. It is unclear whether percutaneous balloon compression (PBC) can be used as the preferred surgical treatment for postoperative recurrent TN. To determine the efficacy of PBC and identify the predictors of response of PBC for the treatment of recurrent TN following TN-related surgeries, we retrospectively collected and analyzed the data of patients with recurrent TN following surgical treatments who underwent PBC under three-dimensional computed tomography (3D-CT) guidance at the Department of Pain Management of Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2022. We found, within 1 month after PBC, that the total efficacy of PBC on recurrent TN following TN-related surgeries was 86.7%. Based on the effectiveness of PBC 1 month postoperatively, patients were divided into the effective group (130, 86.7%) and the ineffective group (20, 13.3%). Fourteen (10.8%) patients in the effective group had undergone RFT before, which was significantly lower than that in the ineffective group (6, 30%, p = 0.02). Multivariate logistic regression analysis showed that previous RFT alone (OR = 0.20, 95%CI 0.06-0.66, P = 0.01) was an independent predictor of the negative response of PBC. Thus, PBC was found to be a moderately effective and safe treatment for recurrent TN after TN-related surgery. However, previous RFT procedures may predict a slightly worse outcome after PBC.
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Xia Y, Yu G, Min F, Xiang H, Huang J, Leng J. The Focus and New Progress of Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia. J Pain Res 2022; 15:3059-3068. [PMID: 36199499 PMCID: PMC9529012 DOI: 10.2147/jpr.s374433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/02/2022] [Indexed: 12/03/2022] Open
Abstract
Trigeminal neuralgia is a condition confined to the trigeminal nerve, causing one or more branches of facial nerve pain. Surgical treatment options for trigeminal neuralgia include microvascular decompression(MVD), percutaneous balloon compression (PBC), radiofrequency thermocoagulation(RF), percutaneous retrogasserian glycerol rhizotomy(PRGR), gamma knife, etc. Of these treatments, PBC is increasingly being used by clinicians for trigeminal neuralgia. PBC is a simple surgical operation performed to treat trigeminal neuralgia. Owing to its advantages, PBC is favored by many clinicians. In this study, we aimed to emphasize the need to analyze the shape of the balloon, position, compression time, and pressure, as these factors can affect the efficacy of PBC. The relief of pain by balloon compression is related to the shape of the balloon on X-ray, which is the key to the operation. Owing to continued progress and advances in current imaging technologies, clinicians revealed that the precise positioning of the foramen ovale is no longer an intraoperative problem. Instead, the anatomy of Meckel’s cave and the shape of the balloon must be the focus to achieve the best treatment effect. For clinicians, PBC is simple and is associated with a short operation time. PBC also has other advantages, such as low cost and immediate postoperative pain relief. The recurrence rate of pain post-PBC is low, despite the occurrence of facial numbness post-op. However, this side effect is reversible and does not affect daily life of the patient. In fact, the patient can be discharged 1–2 days after surgery. Overall, PBC can be considered as one of the preferred surgical methods for the treatment of primary trigeminal neuralgia. In this paper, we explain the main points of PBC operation in detail in terms of Meckel’s cave, surgical procedure, complications, discussion of the focus and new progress, etc.
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Affiliation(s)
- Yinghua Xia
- Medical College of Nanchang University, Nanchang, People’s Republic of China
- Department of Neurosurgery, Jiangxi Provincial People’s Hospital, Nanchang, People’s Republic of China
| | - Gui Yu
- Department of Neurosurgery, Jiangxi Provincial People’s Hospital, Nanchang, People’s Republic of China
- The First Clinical Medical College of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Feixiang Min
- Medical College of Nanchang University, Nanchang, People’s Republic of China
- Department of Neurosurgery, Jiangxi Provincial People’s Hospital, Nanchang, People’s Republic of China
| | - Hui Xiang
- Department of Neurosurgery, Jiangxi Provincial People’s Hospital, Nanchang, People’s Republic of China
- Correspondence: Hui Xiang, Jiangxi Provincial People’s Hospital, No. 266, Fenghe North Avenue, Honggutan District, Nanchang City, People’s Republic of China, Tel +86-13803514563, Email
| | - Jinqing Huang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, People’s Republic of China
- Department of Neurosurgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, People’s Republic of China
- Jinqing Huang, Ganzhou People’s Hospital, No. 16, Meiguan Avenue, Zhanggong District, Ganzhou City, People’s Republic of China, Tel +86-18160779765, Email
| | - Jingxing Leng
- Department of Neurosurgery, Jiangxi Provincial People’s Hospital, Nanchang, People’s Republic of China
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Xu B, Jia ZP, Ren H, Meng L, Shen Y, Wang T, Luo F, Lv R. Clinical Efficacy of a Spiral CT-Guided Balloon Compression Day-Surgery Operation for the Treatment of Trigeminal Neuralgia. Front Neurol 2022; 13:923225. [PMID: 35873781 PMCID: PMC9298876 DOI: 10.3389/fneur.2022.923225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to investigate the clinical efficacy of a balloon compression day-surgery operation under the guidance of spiral computed tomography (CT) three-dimensional (3D) reconstruction for the treatment of trigeminal neuralgia. Methods The clinical efficacy and related indexes of 380 patients with trigeminal neuralgia treated by a spiral CT-guided balloon compression day-surgery operation in the pain department of Beijing TianTan Hospital, from October 2017 to March 2021, were retrospectively analyzed. Results Five patients failed due to foramen ovale puncture or in placing the balloon; two patients had ineffective results after the operation and re-entered the hospital for secondary balloon compression. The initial effective rate of the operation in the 380 patients was 98.16%. All patients were discharged on the day of the operation, the average operation time was 26.46 ± 12.15 min, and the average interval from the completion of the operation to discharge was 2.67 ± 0.95 h. During the follow-up period (1-41 months), 12 patients had pain recurrence, and a Kaplan-Meier analysis revealed that the cumulative pain-free recurrence survival rate at 41 months after the operation was 80.64%. No complications related to foramen ovale puncture occurred. Conclusion The spiral CT-guided balloon compression day-surgery operation is safe, effective, and worthy of clinical promotion.
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Affiliation(s)
- Bing Xu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Pu Jia
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Pain, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Lv
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia. Acta Neurochir (Wien) 2022; 164:1575-1585. [PMID: 35484311 DOI: 10.1007/s00701-022-05224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Radiofrequency thermocoagulation trigeminal rhizotomy (RT-TR) through the foramen ovale is a minimally invasive treatment for trigeminal neuralgia. Navigation of magnetic resonance imaging (MRI) and CT fusion imaging is a well-established method for cannulation of the Gasserian ganglion. In this study, we use the inline measurements from fusion image to analyze the anatomical parameters between the actual and simulation trajectories and compare the short- and intermediate-term outcomes according to determinable factors. METHODS The study included thirty-six idiopathic neuralgia patients who had undergone RT-TR with MRI and CT fusion image as a primary modality or repeated procedures. RESULTS Among thirty-six treated patients, the inline length of the trigeminal cistern was longer for the simulated trajectory (8.4 ± 2.4 versus 6.5 ± 2.8 mm; p < 0.05), and the predominant structure at risk extrapolated from the inline trajectory was the brainstem, which signified a more medially directed route, in contrast with the equal weighting of temporal lobe and brainstem for the actual trajectory. The preoperative visual analogue scale (VAS) was 9.3 ± 1.0, which decreased to 2.5 ± 2.6 and 2.9 ± 3.1 at first (mean, 3 months) and second (mean, 14 months) postoperative follow-up, respectively. The postoperative VAS scores at the two follow-ups were not statistically significant without a covariate analysis. After adjustment for covariate risk factors, the second follow-up sustained therapeutic benefit was evident in patients with no prior history of related treatment, an ablation temperature greater than 70 °C, and needle location within or adjacent to the trigeminal cistern. CONCLUSIONS This preliminary study demonstrated that the needle location between cistern and ganglion also plays a significant role in better intermediate-term results.
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Liao CC, Li JY, Wu KH, Jian ZH, YI XF, Weng ZJ, Chen G. Combination of Preoperative Multimodal Image Fusion and Intraoperative Dyna CT in Percutaneous Balloon Compression of Trigeminal Ganglion for Primary Trigeminal Neuralgia: Experience in 24 Patients. Front Surg 2022; 9:895394. [PMID: 35615652 PMCID: PMC9124886 DOI: 10.3389/fsurg.2022.895394] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 12/21/2022] Open
Abstract
Objective We retrospectively assessed the surgical results of PBC with preoperative multimodal image fusion and intraoperative Dyna Computed Tomography (CT) in 24 patients with primary trigeminal neuralgia (PTN) to explore a valuable aid for Percutaneous balloon compression (PBC). Methods We studied the data of 24 patients with PTN. All patients underwent PBC and were assessed with preoperative multimodal image fusion [computed tomography (CT) and magnetic resonance imaging (MRI)] and intraoperative Dyna CT in the Department of Neurosurgery of Zhuhai People’s Hospital between October 2020 and September 2021. Multimodal image fusion—three-dimensional (3D) reconstruction of CT and MRI data—was performed using 3D-Slicer software, and preoperative evaluation was performed according to the results of image fusion. Dyna CT was used to dynamically observe the position and shape of the metallic hollow introducer and Fogarty catheter and balloon during the operation to guide the operation in real time. We performed follow-up assessments each month and summarized the clinical characteristics, surgical effects, and complications in all patients. Results Surgery was successful for all patients; the patients reported immediate pain relief. Surgical complications included facial numbness in 24 patients (100%), mild masseter weakness in three (12.5%), herpes zoster in three (12.5%), and balloon rupture in one (4.2%). None of the patients had serious surgical complications. The mean follow-up time was 9.6 ± 2.7 months. During the follow-up period, 22 patients (91.7%) experienced no recurrence of pain, and two patients (8.3%) experienced recurrence of pain, of which one underwent secondary PBC surgery. Conclusions Preoperative multimodal image reconstruction can help fully evaluate PBC surgery, clarify the etiology, and predict the volume of contrast medium required during the operation. It provided important assistance for PBC treatment of trigeminal neuralgia patients when preoperative multimodal image fusion is combined with intraoperative Dyna CT.
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Zheng S, Yuan R, Ni J, Liu H, Yang Y, Zhang S, Li J. Long-term Recurrence-free Survival and Complications of Percutaneous Balloon Compression and Radiofrequency Thermocoagulation of Gasserian Ganglion for Trigeminal Neuralgia:A Retrospective Study of 1313 Cases. Pain Pract 2022; 22:532-540. [PMID: 35460524 DOI: 10.1111/papr.13114] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate long-term recurrence, complications after percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFT) of gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up. METHODS A retrospective analysis of 1313 patients undergoing PBC or RFT for the treatment of TN was conducted from 2006 to 2020. Recurrence-free survival (RFS) was assessed by Kaplan-Meier method. Complications including facial numbness, corneal reflex decrease and masseter weakness were also estimated. RESULTS For patients who received first initial PBC and RFT, the median RFS was 130.1 months (95%CI: 124.4, 135.9) and 123.3 months (95%CI: 117.6, 128.9) in PBC and RFT group with log-rank p=0.108. The RFS rate was respectively 90.6% (95%CI: 88.1%-93.3%) and 91.4% (95%CI: 89.1%-93.7%) at 1 year, 84.6% (95%CI: 81.4%-87.8%) and 83.3% (95%CI: 80.3%-86.3%) at 3 years, 81.5% (95%CI: 78.1%-85.0%) and 78.6 % (95%CI: 75.2%-81.9%) at 5 years, 71.5% (95%CI: 67.5%-75.5%) and 64.8% (95%CI: 61.0%-68.7%) at 10 years in two groups. No significant difference was observed in facial numbness degree between two groups after procedure. Compared with PBC group, ophthalmic complication prevalence was higher in RFT group (9.6%) (p=0.001). However, masseter weakness incidence was lower (10.7%) than that in PBC group (24.0%) with p<0.001. CONCLUSIONS Patients with TN seemed to attain similar long-term benefit from PBC and RFT, especially in elderly. However, in order to reduce postoperative complications, PBC provided a safer and alternative for treating TN involving ophthalmic division, whereas RFT could be employed as a preferred regimen for maxillary and mandibular TN.
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Affiliation(s)
- Shuyue Zheng
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University, No. 10 Yangfangdian Street, 100038, Haidian District, Beijing, China
| | - Rong Yuan
- Department of Ultrasound Diagnosis, North District of Peking University Third Hospital, No. 10 Chedaogou, 100080, Haidian District, Beijing, China
| | - Jiaxiang Ni
- Department of Pain Management, Beijing Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, 100053, Xicheng District, Beijing, China
| | - Hongfu Liu
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University, No. 10 Yangfangdian Street, 100038, Haidian District, Beijing, China
| | - Yucheng Yang
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University, No. 10 Yangfangdian Street, 100038, Haidian District, Beijing, China
| | - Shusheng Zhang
- Department of Neurosurgery and Pain, Tsinghua University Affiliated Yuquan Hospital, No. 5 Shijingshan Street, 100049, Shijingshan District, Beijing, China
| | - Juanhong Li
- Department of Pain, Beijing Shijitan Hospital, Capital Medical University, No. 10 Yangfangdian Street, 100038, Haidian District, Beijing, China
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Liu Q, Wang J, Wang C, Chen W, Chen W, Ye X, Mao Z, Zhang C, Xu J. Robot-Assisted Percutaneous Balloon Compression for Trigeminal Neuralgia: Technique Description and Short-Term Clinical Results. Front Surg 2022; 9:869223. [PMID: 35372483 PMCID: PMC8971286 DOI: 10.3389/fsurg.2022.869223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Percutaneous balloon compression (PBC) is a minimally invasive treatment for trigeminal neuralgia (TG) with a favorable cost-effectiveness ratio, but this technique has a steep learning curve. This study presents our initial clinical experience of robot-assisted PBC using a neurosurgical robot on six consecutive patients with TG. Methods We fixed the patient's head with a skull clamp and connected it with the linkage arms of a Sinovation® neurosurgical robot, which was then registered using four bone fiducials by the robotic pointer. The puncture needle was positioned at the entry point on the skin using a robotic arm and advanced to the target point after the skin had been incised with a pointed surgical blade. This procedure was repeated for a second trajectory. A balloon was then advanced and inflated using 0.3 ml of a contrast agent. Upon injection of 0.6 ml contrast agent, the ganglion was kept compressed for 120 s. After removal of the balloon and puncture needle, compression of the face was performed to achieve hemostasis. Results All patients achieved immediate pain relief following PBC. No permanent or severe complications were registered, and there was no pain recurrence in any of the patients during the follow-up period. Conclusions Despite requiring a longer time for preoperative preparation, robot-assisted PBC provided a high degree of accuracy and safety, and it can also shorten the learning curve for surgeons unfamiliar with PBC. Robot-assisted surgical approaches should be further developed and adopted for PBC.
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Affiliation(s)
- Qiangqiang Liu
- Department of Neurosurgery, Clinical Neuroscience Center Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Qiangqiang Liu
| | - Junjie Wang
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changquan Wang
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenze Chen
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenzhen Chen
- Department of Neurosurgery, Clinical Neuroscience Center Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolai Ye
- Department of Neurosurgery, Clinical Neuroscience Center Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyu Mao
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Research Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Jiwen Xu
- Department of Neurosurgery, Clinical Neuroscience Center Comprehensive Epilepsy Unit, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiwen Xu
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