Neuronavigation assisted percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. How I do it.
Ontology highlight
ABSTRACT:
SUBMITTER: Rochat P
PROVIDER: S-EPMC11291522 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
Publications
Neuronavigation assisted percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. How I do it.
Rochat P P Springborg J B JB Birkeland P P Agerlin N N
Acta neurochirurgica 20240731 1
<h4>Background</h4>Surgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007-1012, 6).<h4>Method</h4>Here we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection.<h4>Conclusion</h4>The navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and ...[more]
Similar Datasets
Project description:BackgroundC-arm-guided percutaneous puncture balloon compression alone has risk factors of puncture failure, complications, and poor prognosis. Robot-assisted PBC can effectively increase the one-time puncture success rate and improve the safety of the procedure. However, evidence on the superiority of robot-assisted PBC over C-arm-guided PBC alone remains relatively limited.MethodsRetrospective analysis The clinical data of 60 patients with trigeminal neuralgia aged 60 years or older in the Department of Neurosurgery of the Fourth Hospital of Harbin Medical University from January 2021 to October 2021. There were 29 males and 31 females, and the patients' ages ranged from 60 to 79 years, with an average of 71.63 ± 5.12 years. Two groups were divided according to the surgical method, the C-arm guidance-only group (30 cases, n = 30) and the robot-assisted group (30 cases, n = 30). The success rate of first puncture, total operation time, number of "pear-shaped" balloons, number of C-arm x-ray scans, and immediate postoperative relief rate were recorded in both groups, and follow-up was performed to evaluate the postoperative results and complications. The overall evaluation of postoperative results and complications was performed.ResultsIntraoperative balloon compression was successfully completed in all 60 patients, and the first puncture success rate was higher in the robot-assisted group than in the simple C-arm group, with a significant difference between the two groups (P < 0.001). In terms of intraoperative balloon morphology, the number of "pear-shaped" balloons was higher in the PBC than in the C-arm-only PBC group, with a significant difference between the two groups (P < 0.005). The degree of immediate postoperative remission in the robotic group was 0 VAS score, which was not statistically significant in both groups (P > 0.05). By the final follow-up, the mean VAS score of the robot-assisted group was lower than that of the simple C-arm group, and both were statistically significant (P < 0.05); complications of masticatory muscle weakness or abnormal facial sensation occurred in both groups after surgery, but the number of cases in the robot-assisted group was less than that of the simple C-arm group.ConclusionRobot-assisted PBC is better than PBC with a C-arm x-ray machine in terms of first puncture success rate, number of intraoperative balloon "pear-shaped" cases, number of C-arm x-ray scans and short-term efficacy.
| S-EPMC9632997 | biostudies-literature
Project description:Percutaneous balloon ganglyolysis (PBG) for trigeminal neuralgia (TN) is an inexpensive and minimally invasive treatment modality that is effective and safe. While there are reports of its efficacy, there is still a lack of evidence of which patients are at a higher risk of treatment failures and needing retreatment. We performed a retrospective study at a major academic institution from 2012 to 2023, including TN patients who underwent PBG procedures to evaluate predictors of retreatment. Patients without imaging available from the PBG were excluded. Fifty-two patients who underwent 83 procedures in total were included in the analysis. All patients had typical TN and were primarily female (59.6%), with a median age of 61.5 years. Immediately after PBG, 42.3% had pain resolution, and 57.7% had improved but persistent pain. 30.8% underwent retreatment with PBG in a median of 32 months. From multiple factors assessed, TN disease duration ≤ 6 months and trigeminal nerve enhancement on pre-operative MRI were identified as significant retreatment predictors on univariate analysis. However, after performing logistic regression, only TN disease duration ≤ 6 months remained significant OR 3.99 (95% CI 1.59-10.0; p = 0.003). This was further confirmed in a Kaplan-Meier survival analysis, which showed that patients with TN duration ≤ 6 months require retreatment earlier (22 vs. 41 months; p = 0.01). Retreatment after PBG occurs roughly in a third of patients, and TN disease duration of ≤ 6 months is an important predictor in this study. Further studies should be performed to confirm these findings, which may impact treatment considerations in the future.
| S-EPMC11604742 | biostudies-literature
Project description:Percutaneous radiofrequency thermocoagulation (RFT) of the Gasserian ganglion is an effective treatment for primary trigeminal neuralgia (pTN). Currently Hartel anterior approach is the most commonly used method to access the Gasserian ganglion. However, this approach is associated with high recurrence rate and technical difficulties in certain patients with foramen ovale (FO) anatomical variations. In the present study, we assessed the feasibility of accessing the Gasserian ganglion through the FO from a mandibular angle under computed tomography (CT) and neuronavigation guidance.A total of 108 patients with TN were randomly divided into 2 groups (Group G and Group H) using a random number table. In Group H, Hartel anterior approach was used to puncture the FO; whereas in Group G, a percutaneous puncture through a mandibular angle was used to reach the FO. In both groups, procedures were guided by CT imaging and neuronavigation. The success rates, therapeutic effects, complications, and recurrence rates of the 2 groups were compared.The puncture success rates in Group H and Group G were 52/54 (96.30%) and 49/54 (90.74%), respectively (P = 0.24). The 2 procedural failures in Group H were rescued by using submandibular trajectory, and the 5 failures in Group G were successfully reapproached by Hartel method. Therapeutic effects as measured by Barrow Neurological Institute (BNI) pain scale (P = 0.03) and quality of life (QOL) scores (P = 0.04) were significantly better in Group G than those in Group H at 36 months posttreatment. Hematoma developed in 1/54 (1.85%) cases in Group H, and no cases of hematoma were observed in Group G (P = 0.33). In Group H, RFT resulted in injury to the unintended trigeminal nerve branches and motor fibers in 27/52 (51.92%) cases; in Group G, it resulted in the same type of injury in 7/49 cases (14.29%) (P < 0.01). In Group H, the 24- and 36-month recurrence rates were 12/51 (23.53%) and 20/51 (39.22%), respectively; in Group G, these recurrence rates were 7/49 (12.24%) and 9/49 (16.33%, P = 0.03), respectively.CT- and neuronavigation-guided puncture from a mandibular angle through the FO into the Gasserian ganglion can be safely and effectively used to deliver RFT for the treatment of pTN. This method may represent a viable option to treat TN in addition to Hartel approach.
| S-EPMC5059051 | biostudies-literature
Project description:BackgroundBalloon compression (BC) is a simple and effective operation to treat trigeminal neuralgia (TN). The most difficult procedure in BC is related to fast and accurate foramen ovale (FO) insertion. In this study, we introduced a new method incorporating a personalized tooth-supported digital guide plate to reduce patient trauma, improve the accuracy and the success rate of insertion, and reduce surgeons' radiation exposure.MethodsIn total, 15 TN patients aged 55-70 years were recruited between January 2019 and November 2020 and retrospectively analyzed. Before the operation, based on Mimics 3D reconstruction and the modeling of patients' maxillary teeth, personalized tooth-supported digital guide plates were designed and 3D printed. All operational procedures were simulated. Then, all patients underwent BC with a personalized tooth-supported digital guide plate.ResultsIn the study, guide plate insertion was completed within 60 seconds for all patients. Puncturing time was limited to 5 seconds. Successful insertion into the FO was achieved in 1 attempt for all 15 participants. No patients required more than 3 postinsertion adjustments to obtain a pear-shaped balloon. There were no postoperative complications, such as cerebrospinal fluid leakage, intracranial infection, or visual acuity change. The trigger points, attack frequency per day, attack duration, and Barrow Neurological Institute (BNI) pain intensity scores of all 15 participants were significantly improved postoperation. The visual analog scale (VAS) score significantly decreased postoperation compared with that obtained preoperation (all P<0.001) and gradually decreased with the extension of follow-up time.ConclusionsBy applying a personalized tooth-supported digital guide plate, we can significantly avoid the use of an incision outside the mouth, decrease the difficulty of FO insertion, and reduce patient trauma. The operation is more suitable for novice surgeons and protects surgeons from the harm of radiation. This new technology may improve the success rate and accuracy of FO insertion, although a multicenter, large sample, randomized controlled trial is needed.
| S-EPMC9263769 | biostudies-literature
Project description:Neurovascular compression syndromes are usually caused by arteries that directly contact the cisternal portion of a cranial nerve. Not all cases of neurovascular contact are clinically symptomatic. The transition zone between the central and peripheral myelin is the most vulnerable region for symptomatic neurovascular compression syndromes. Trigeminal neuralgia (cranial nerve V) has an incidence of 4-20/100,000, a transition zone of 4 mm, with symptomatic neurovascular compression typically proximal. Hemifacial spasm (cranial nerve VII) has an incidence of 1/100,000, a transition zone of 2.5 mm, with symptomatic neurovascular compression typically proximal. Vestibular paroxysmia (cranial nerve VIII) has an unknown incidence, a transition zone of 11 mm, with symptomatic neurovascular compression typically at the internal auditory canal. Glossopharyngeal neuralgia (cranial nerve IX) has an incidence of 0.5/100,000, a transition zone of 1.5 mm, with symptomatic neurovascular compression typically proximal. The transition zone overlaps the root entry zone close to the brain stem in cranial nerves V, VII, and IX, yet it is more distal and does not overlap the root entry zone in cranial nerve VIII. Although symptomatic neurovascular compression syndromes may also occur if the neurovascular contact is outside the transition zone, symptomatic neurovascular compression syndromes are more common if the neurovascular contact occurs at the transition zone or central myelin section, in particular when associated with nerve displacement and atrophy.
| S-EPMC7960264 | biostudies-literature
Project description:The epigenetic roles in trigeminal neuralgia (TN) still remain unclear. H3K9ac alteration in neuralgia is obscure and controversy. In this study, we established TN rat model via chronic compression, and further treated with 100 mg/kg/d carbamazepine (CBZ). RNA-seq were conducted to investigate the transcriptional profilings in control, TN and TN+CBZ.
2021-08-02 | E-MTAB-10792 | biostudies-arrayexpress
Project description:ObjectiveTo determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC).Materials and methodsFrom May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls.ResultsIn TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579-0.758) for APR and 0.700 (CI: 0.607-0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°).ConclusionIn patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.
| S-EPMC9340232 | biostudies-literature
Project description:Trigeminal neuralgia (TN) is a unique pain disorder characterized by intense paroxysmal facial pain within areas innervated by the trigeminal nerve. Although most cases of TN are sporadic, familial clusters of TN suggest that genetic factors may contribute to this disorder. Whole-exome sequencing in patients with TN reporting positive family history demonstrated a spectrum of variants of ion channels including TRP channels. Here, we used patch-clamp analysis and Ca2+ and Na+ imaging to assess a rare variant in the TRPM7 channel, p.Ala931Thr, within transmembrane domain 3, identified in a man suffering from unilateral TN. We showed that A931T produced an abnormal inward current carried by Na+ and insensitive to the pore blocker Gd3+. Hypothesizing that replacement of the hydrophobic alanine at position 931 with the more polar threonine destabilizes a hydrophobic ring, near the voltage sensor domain, we performed alanine substitutions of F971 and W972 and obtained results suggesting a role of A931-W972 hydrophobic interaction in S3-S4 hydrophobic cleft stability. Finally, we transfected trigeminal ganglion neurons with A931T channels and observed that expression of this TRPM7 variant lowers current threshold and resting membrane potential, and increases evoked firing activity in TG neurons. Our results support the notion that the TRPM7-A931T mutation located in the S3 segment at the interface with the transmembrane region S4, generates an omega current that carries Na+ influx in physiological conditions. A931T produces hyperexcitability and a sustained Na+ influx in trigeminal ganglion neurons that may underlie pain in this kindred with trigeminal neuralgia.
| S-EPMC9499596 | biostudies-literature
Project description:ObjectThis study describes an experimental rabbit model that allows the reproduction of percutaneous operations that are used in patients with trigeminal neuralgia (TN). Attention was given to an exact anatomical description of the rabbit's middle cranial fossa as well as the establishment of conditions for a successful procedure.MethodsMorphometric measurements were taken from 20 rabbit skulls and CT scans. The anatomy of the trigeminal nerve, as well as its surrounding structures, was assessed by bilateral dissection of 13 New Zealand white rabbits (NWR). An ideal approach of placing a needle through the foramen ovale to reach the TG was sought. Validation of correct placement was realized by fluoroscopy and confirmed by dissection.ResultsPrecise instructions for successful reproduction of percutaneous procedures in NWR were described. According to morphological measurements, for balloon compression of the trigeminal ganglion (TG) the maximal diameter of an introducing cannula is 1.85 mm. The diameter of an empty balloon catheter should not exceed 1.19 mm, and the length of the inflatable part of the balloon can range up to 4 mm. For thermocoagulation the needle electrodes must not exceed an external diameter of 1.39, mm and the length of the non-insolated tip can range up to 4 mm. Glycerol rhizolysis can be achieved because the trigeminal cistern in the NWR is a closed space that allows a long dwelling time (>10 min) of the contrast agent.ConclusionsAn experimental NWR model intended for the reproduction of percutaneous procedures on the TG has been meticulously described. This provides a tool that enables further standardized animal research in the field of surgical treatment of TN.
| S-EPMC5486611 | biostudies-literature
Project description:IntroductionConventional management approaches have been challenged in dealing with zoster-related trigeminal neuralgia. Percutaneous trigeminal ganglion stimulation (TGS) has been rarely reported as a potential treatment option for alleviating pain associated with this condition. The present study investigated the application of percutaneous TGS in a series of patients suffering from Zoster-related trigeminal neuralgia to evaluate its potential efficacy of pain relief.MethodsWe retrospectively reviewed the medical records of all patients who underwent TGS at the Department of Pain Management, Second Affiliated Hospital of Guangxi Medical University. All patients were followed for up to 6 months. Clinical data, including the Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and medication consumption were recorded before and after treatment. Adverse events related to the treatment were also documented.ResultsA total of nine patients underwent percutaneous TGS for Zoster-related trigeminal neuralgia. Among these patients, five (56%) experienced more than 50% pain relief at discharge. At the six-month follow-up, the mean VAS score decreased from preoperative 6.1 ± 1.5 to 2.5 ± 1.9, demonstrating a statistically significant reduction (t = 4.36, p < 0.05). The PSQI also showed a significant reduction from a baseline score of 14.1 to 6.5 at the six-month follow-up (Z = 4.2, p < 0.05). Seven patients reported satisfaction with the treatment and no serious adverse events occurred.DiscussionThe results of the present study suggest that this contributes growing evidence that percutaneous TGS may be an effective treatment for Zoster - related trigeminal neuralgia.
| S-EPMC11747470 | biostudies-literature