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Morphology of the trigeminal ganglion: anatomical structures related to trigeminal radiofrequency rhizotomy

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

Trigeminal neuralgia is the most common example of craniofacial neuralgia. Its etiology is unknown and is characterized by severe episodes of paroxysmal pain. The trigeminal ganglion and its adjacent anatomical structures have a complex anatomy. The foramen ovale is of great importance during surgical procedures such as percutaneous trigeminal rhizotomy for trigeminal neuralgia.

Objective

We aimed to identify the anatomical structures associated with the trigeminal ganglion and radiofrequency rhizotomy on cadavers and investigate their relationship with the electrodes used during rhizotomy to determine the contribution of the electrode diameter and length to the effectiveness of the lesion formation on the ganglion.

Methods

Five fresh-frozen cadaver heads injected with red silicone/latex were used. A percutaneous puncture was made by inserting of a cannula through the foramen ovale to create a pathway for electrodes. The relationships between the electrodes, Meckel’s cave, trigeminal ganglion, and neurovascular structures were observed and morphometric measurements were obtained using a digital caliper.

Results

Trigeminal ganglion, therefore the electrode in its final position, shows proximity with important anatomical structures. The electrode was inserted posteriorly into the foramen ovale in all of the specimens and was located on the retrogasserian fibers. This study revealed that the electrodes targeting the ganglion and passing through the foramen ovale may cause a radiofrequency lesion due to the contact effect of the dura itself pressing on the electrode. Pushing the cannula beyond the petroclival angle may result in puncturing of the dura propria and moving further away from the target area.

Conclusion

The success of radiofrequency rhizotomy is directly related to the area affected by the lesion. Understanding the mechanism of action underlying this procedure will ensure the effectiveness, success, and sustainability of the treatment.

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Acknowledgements

This study was abstracted from the data of a specialty thesis in neurosurgery given by the first author (EYS) under the supervision of the senior author (AS) at Ankara University School of Medicine. The authors wish to thank all cadaver donors used in this study and their families. The authors wish to thank senior biostatistician Salih ERGOCEN MSc for the elaborate analyses of morphometric data of the whole study. The authors wish to thank ENAGO for its English editing and manuscript proofreading services.

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Authors and Affiliations

  1. Department of Neurosurgery, Ankara University School of Medicine, Ankara, 06230, Turkey

    Emre Yagiz Sayaci, Gokmen Kahilogullari & Ali Savas

  2. Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey

    Ayhan Comert, Ali Can Korkmaz & Yigit Gungor

  3. Department of Neurosurgery, Karabuk University School of Medicine, Karabuk, Turkey

    Tugba Morali Guler

  4. Department of Neurosurgery, Yuksek Ihtisas University School of Medicine, Ankara, Turkey

    Yahya Efe Guner

  5. Department of Pathology, Ankara University School of Medicine, Ankara, Turkey

    Cevriye Cansiz Ersoz & Aylin Okcu Heper

Authors
  1. Emre Yagiz Sayaci
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  2. Gokmen Kahilogullari
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  3. Ayhan Comert
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  6. Ali Can Korkmaz
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  7. Yigit Gungor
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  8. Cevriye Cansiz Ersoz
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  9. Aylin Okcu Heper
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  10. Ali Savas
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Corresponding author

Correspondence to Emre Yagiz Sayaci.

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Ethics approval and consent to participate

This study includes no use of live subjects or animals in any way. This is a cadaveric study and all cadavers were supplied from a donated institution with subjects giving written informed consent to be utilized in scientific studies. All the performed procedures in this study that involve cadavers followed the ethical standards of the Institutional Review Board and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Functional Neurosurgery—Pain

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Sayaci, E.Y., Kahilogullari, G., Comert, A. et al. Morphology of the trigeminal ganglion: anatomical structures related to trigeminal radiofrequency rhizotomy. Acta Neurochir 164, 1551–1566 (2022). https://doi.org/10.1007/s00701-022-05160-7

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  • DOI: https://doi.org/10.1007/s00701-022-05160-7

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