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The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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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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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Branch, Chia-Yi, 61363, Taiwan

    Wei-Chao Huang, Kuo-Tai Chen, Chih-Hao Kao, Jen-Tsung Yang, Ming-Hsueh Lee & Martin Hsiu-Chu Lin

  2. College of Medicine, Chang Gung University, Tao-Yuan, 33302, Taiwan

    Jen-Tsung Yang

  3. Chang Gung University of Science and Technology, Chia-Yi, Taiwan

    Ming-Hsueh Lee

Authors
  1. Wei-Chao Huang
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  2. Kuo-Tai Chen
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Correspondence to Martin Hsiu-Chu Lin.

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Ethics approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the institutional review board (CMRPG6C0201).

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Patient consent was waived owing to the retrospective design of the study, which used clinical data available from medical records.

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The authors declare no competing interests.

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Comments

The authors share with us their experience with radiofrequency rhizotomy for the treatment of trigeminal neuralgia and present an interesting study regarding the potential impact of needle position on clinical outcome. Although percutaneous procedures are an important part of the neurosurgical armamentarium in the treatment of patients suffering from trigeminal pain and among these thermorhizotomy is considered an effective and safe method, reaching the trigeminal cistern can be challenging and the methods used for this vary and are highly controversial.

In the present study, neuronavigation by fusion of MRI and CT data sets and inline measurements were used to analyze the anatomical parameters between the actual and simulated trajectories and compare the patient outcomes according to better determinable factors. Although preliminary and considering the quite relevant study limitations, the results suggest that needle locations between cistern and ganglion play a significant role in improving at least the intermediate-term outcome. Both the discussion of optimal anatomical needle position within the trigeminal cistern and its insertion and verification is not new and remains lively. I congratulate the authors on their work and on the fact that they have contributed to highlight and further clarify these problems.

Markus F. Oertel

Zurich, Switzerland

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

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Huang, WC., Chen, KT., Kao, CH. et al. The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia. Acta Neurochir 164, 1575–1585 (2022). https://doi.org/10.1007/s00701-022-05224-8

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  • DOI: https://doi.org/10.1007/s00701-022-05224-8

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