Cone Beam CT With Flat Panel Detector and Biplane Fluoroscopy-Guided Percutaneous Trigeminal Nerve Rhizotomy Using Three-Dimensional Needle Trajectory Planning

Abstract

Trigeminal-mediated pain disorders can be devastating for patients refractory to medical therapy. Gasserian ganglion blocks and percutaneous trigeminal rhizotomy have been used with success to treat these patients, however, serious complication risks include facial hematoma, cranial nerve palsy, and stroke. Cone beam CT, combined with fluoroscopy and needle navigation has been shown to decrease needle pass rates, procedure time, radiation exposure, and complications in multiple interventional radiology procedures, but hitherto has not been utilized for Gasserian ganglion interventions. Here, we present two cases of trigeminal-mediated pain successfully treated via cone beam CT combined fluoroscopy and needle navigation.

Anatomic Variations of Foramen Ovale as a Predictor of Successful Cannulation in Percutaneous Trigeminal Rhizotomies

“…CT-navigational guidance has become a more common practice, increasing cannulation success, reducing complications, and enhancing overall safety in percutaneous trigeminal rhizotomies. 14,15,[25][26][27][28][29][30][31][32][33][34][35] Given that these patients will often have a preoperative thin-cut CT scan, examining the FO before committing to a percutaneous procedure is a reasonable approach for the clinician. For instance, radiofrequency ablation for TN uses a smaller-diameter Tuohy needle (22G or 23G) compared with the Tuohy needle for balloon compression (14G).…”