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Background: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure., Methods: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group., Results: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years., Conclusion: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications., Competing Interests: Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the University Hospital Pilsen and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Radiofrequency thermal rhizotomy demonstrates an excellent treatment outcome with a high success rate among patients of intractable trigeminal neuralgia. The triangular plexus which is an immediate retrogasserian portion of the trigeminal root is suggested as the best place of lesioning during radiofrequency thermal rhizotomy. However, the anatomy of the triangular plexus has been relatively unrecognized, while the anatomical study related to therapeutic procedure is scarce., Objective: The purpose of this study is to confirm with gross and microscopic finding of the trigeminal system whether, if an electrode tip is placed on the petroclival junction in lateral cranial view, it actually arrives at the triangular plexus or not. In relation to therapeutic procedure, we examined the triangular plexus with morphological and histological methods., Study Design: Human cadaveric study., Setting: An anatomical laboratory in South Korea., Methods: Percutaneous procedure of radiofrequency thermal rhizotomy under C-arm guidance was performed in 8 cadavers. Final target of the electrode tip was the petroclival junction under true lateral cranial view. The location of the electrode tip was determined under observation of the presence of an injected dye. Triangular plexus size was measured grossly and microscopically. Gross and microscopic evaluation of the triangular plexus was performed., Results: Among 15 trigeminal systems, 8 showed dye appearance in the triangular plexus, while 6 showed it in the trigeminal ganglion. Overall, 53% of radiofrequency thermal rhizotomy could reach the triangular plexus when an electrode tip was placed on the petroclival junction. The grossly measured average triangular plexus vertical and transverse diameters were 0.8 cm and 1.3 cm, respectively., Limitation: Only radiologic landmark was used to confirm the location of the electrode tip. However, further study confirming the location of the electrode tip under the guidance of electrical stimulation is needed., Conclusion: When an electrode tip was placed on the petroclival junction, 53% of radiofrequency thermal rhizotomy could reach the triangular plexus.

Background: Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is comparatively rare and larger series of percutaneous balloon compression (PBC) in such cases are few in the literature., Objective: To evaluate the results after PBC for MS-TN with regards to therapeutic effect, side effects, and complications., Methods: One hundred eleven procedures with PBC performed in 66 cases of MS-TN were analyzed. Therapeutic effect was measured as postoperative time to pain recurrence without medication. All complications were compiled and the sensory function was evaluated in a subgroup of cases., Results: The initial pain free rate was 67% and the median time to pain recurrence was 8 mo. Thirty-six patients were treated with PBC only, and among them, the results were worse if treated 3 to 4 times before, compared to first treatment (P = .009-.034). Patients who had several PBCs had worse results already after the first surgery (P < .001). A significant number of patients had impaired sensation to light touch directly after surgery, which was normalized at the late follow-up. Sensimetric testing showed raised thresholds for perception and pain directly after surgery (P = .004-.03), but these were also normalized at the late follow-up., Conclusion: PBC is a treatment that can be effective for many patients with MS-TN. Repeated previous surgeries is a risk factor for an unsatisfactory outcome. However, the patients with multiple surgeries had less satisfactory results already at the first procedure, indicating that a therapy resistant disease can be predicted after the first two PBCs. Postoperative sensory deficits were common but not lasting., (Copyright © 2019 by the Congress of Neurological Surgeons.)

Background: Percutaneous trigeminal rhizotomy (PTR) uses fluoroscopic guidance to cannulate the foramen ovale for the treatment of trigeminal neuralgia., Objective: To describe the use of a high-resolution biplane neuroangiosuite for PTR and retrospectively to assess the performance of this technique., Methods: From 1990 through 2010, 67 PTRs were performed in 51 patients at our institution; 47 used the c-arm in the operating room (OR) and 20 used the biplane angiosuite. Hospital charts were reviewed for demographics, symptomatology, operative time, number of cannulation attempts, fluoroscopy time and pain outcome. Two-tailed univariate analyses were performed to compare the OR and angiosuite groups., Results: In 20 of 67 PTRs, biplane fluoroscopic guidance in the angiosuite was used. Variations in type of PTR, fluoroscopy technique and follow-up time barred meaningful comparison of these variables between OR and biplane groups. However, the biplane group had significantly fewer mean cannulation attempts (1 vs 2.2, p<0.001)., Conclusions: High-resolution biplane neuroangiosuites offer a readily available alternative to ORs for PTR in the treatment of trigeminal neuralgia. Use of the biplane fluoroscopy machine was practical, safe and at least as effective as the use of the c-arm. It may also offer the advantages of a reduced number of cannulation attempts., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: Percutaneous ganglion balloon compression (PBC) is a minimally invasive procedure for treatment of trigeminal neuralgia., Materials and Methods: Twenty-seven (19 female and 8 male) patients, who presented with classical symptoms of trigeminal neuralgia, were included. Age ranged from 34 to 91 years (median 62 years), 33 procedures were performed. Duration of the symptoms ranged from 1 year to 30 years (median 5 years)., Results: After the procedure, pain relief was reported in 25 (93%) patients. In two patients, the pain remained the same. The pain free period ranged from 2 to 74 months (median 15 months). A mean duration of analgesia was longer in patients with ideal pear shape of balloon at the time of the procedure compared to nonideal shape (P = 0.01). No major complications occurred in our group of patients., Conclusions: Percutaneous trigeminal ganglion balloon compression is a safe, simple, and effective method for temporary pain relief in a selective group of trigeminal neuralgia patients.

We aim to evaluate the mechanisms responsible for complications during trigeminal rhizotomy via foramen ovale puncture. Ten dry skulls and 10 skull-base specimens were investigated in the present study. In cadaveric skull-base specimens, the anatomical relationships between the foramen ovale, mandibular nerve and Gasserian ganglion and the surrounding neurovascular structures were investigated intradurally. The distance between the foramen ovale and Gasserian ganglion was measured as 6 mm. The abducent nerve, adjacent to the anterior tail of the petrolingual ligament, was observed passing along the lateral wall of the cavernous sinus. Advancement of the catheter more than 10 mm from the foramen ovale is likely to damage the internal carotid artery and the abducent nerve at the medial side of the petrolingual ligament. Thermocoagulation of the lateral wall of the cavernous sinus may damage the cranial nerves by heat, giving rise to pareses.

We analyzed 417 patients with trigeminal neuralgia who underwent microvascular decompression (MVD; n = 146) or percutaneous procedures, i.e. radiofrequency rhizotomy (RFR; n = 235) and glycerol rhizotomy (GR; n = 36) between March 1973 and December 1996. MVD and RFR showed the highest rates of initial pain relief (MVD 96.5%; RFR 92.3%; GR 82.8%). RFR and GR had 5.1 and 3.3% rates of facial dysesthesia, respectively, and MVD had the lowest rate (0.3%). Among 9 cases (8.6%) with recurrences after MVD, 8 cases underwent RFR and all of them obtained good long-term results (7.2 years on average). We concluded that MVD is the treatment of choice for tolerant younger patients and should be recommended for patients who desire no sensory deficit. We also determined that radiofrequency rhizotomy is the procedure of choice for patients in whom MVD failed.

Despite the establishment of the vasculoneural compression as a frequent cause of trigeminal neuralgia, minimally invasive surgical techniques to treat medically refractory trigeminal neuralgia are needed in order to minimize the risks associated with craniotomy. Percutaneous retro gasserian glycerol rhizotomy (PRGR) is one of the alternative surgical treatments to microvascular decompression. Technical simplicity, less chance of trigeminal sensory loss, no need of intraoperative sensory testing, and no attempted deliberate destruction of the trigeminal nerve are advantages over other percutaneous trigeminal operations.

We assessed thresholds for sensation of temperature and pressure and temporal summation of pain in the trigger area on the painful side and the contralateral nonpainful side in patients with trigeminal neuralgia previously treated with percutaneous retrogasserian glycerol rhizotomy (PRGR). Temperature and tactile thresholds were significantly increased on the painful side in both pain-free patients and patients with paroxysmal pain, but sensory loss was not more severe in patients with paroxysmal pain, except for increased warm thresholds. Abnormal temporal summation of pain (including progressive increase of pain intensity with radiation of pain and aftersensation) was present in the trigger area of patients with paroxysmal pain, but not in pain-free patients. Thus, relief of trigeminal neuralgia after PRGR involves normalization of abnormal temporal summation of pain, whereas sensory loss is less affected.

The techniques of two experimental surgical operations on the trigeminal nerve are described, namely, excision of the trigeminal ganglion (ganglionectomy) and division of the trigeminal root (rhizotomy), in the cat. These techniques have been developed with the specific aims of achieving the trigeminal lesion and also preserving a satisfactory postoperative quality of life for the animal in order to make it possible to study the long-term effects of trigeminal dennervation. To the best of our knowledge, a detailed description of such a surgical methodology is lacking; reporting of these procedures may facilitate future research on the trigeminal nerve.

Percutaneous rhizotomy of the trigeminal ganglion is an established technique in the management of trigeminal neuralgia. Meningitis has been reported as a complication of radiofrequency rhizotomy. We report two cases in which percutaneous glycerol injection of the trigeminal ganglion was followed by meningitis due to oral streptococci. While initial laboratory features might be considered consistent with meningitis due to Streptococcus pneumoniae, optimal therapy is likely to differ as a consequence of current antimicrobial susceptibility patterns.

The blink reflex was prospectively studied in 28 patients with trigeminal neuralgia, prior-to and following percutaneous glycerol rhizotomy to the Gasserian ganglion. Fifteen patients (54%) had varying degrees of sensory loss in the trigeminal nerve distribution already before glycerol injection. Three more patients developed sensory loss following glycerol injection. Thus following glycerol injection 18 patients had graded sensory loss. Pre-injection the blink reflex showed abnormal R1 wave in 57% patients, while direct and consensual R2 waves were abnormal in 43% and 48%, respectively. Post-injection R1 wave was abnormal in 64% patients. Direct R2 waves were abnormal in 33% patients. Thus clinical findings of sensory loss correlated well with pre-and post-injection blink reflex abnormality. Postoperatively R1 and ipsilateral R2 latencies from the side of the injection deteriorated and consensual R2 latency improved, thus, signifying better function on the contralateral side following relief of pain by glycerol rhizotomy.