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

Sayacı, Emre Yağız; Kahiloğulları, Gökmen; Cömert, Ayhan; Guler, Tugba Morali; Güner, Yahya Efe; Korkmaz, Ali; Güngör, Yiğit; Ersöz, Cevriye Cansız; Heper, Aylın Okçu; Savaş, Ali

doi:10.1007/s00701-022-05160-7

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…11,12 Anatomically, this concurs with Sayaci et al's cadaveric study that found that cannulation always occurred through the posterior aspect of the foramen ovale and the trigeminal nerve was pierced retrogasserian nearest to V3 fibers. 19 These studies suggest that with head flexion, glycerol may flow anteriorly toward the V1 segment.…”

Section: Discussionmentioning

confidence: 94%

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia

Piper

Flores-Milan

Cruz

et al. 2023

J Neurol Surg B Skull Base

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Objective We aim to describe a novel positioning technique using a specific surgical table to achieve the optimal angle during percutaneous glycerol rhizotomy (PGR) for trigeminal neuralgia (TN). Design This is a descriptive and photographic analysis of successful cases for future implementation. Setting This study was conducted at a single-institution, academic center. Participants The participants were adult patients with TN who underwent PGR and provided consent for publication. Main Outcome Measures Primary outcomes of this study were TN symptomatic relief and surgical complications. Results The use of a beach chair sliding headboard surgical table for PGR is plausible and ensures precise and immobile head flexion for 1 hour postglycerol injection. There were no intraoperative or postoperative complications. All patients achieved successful reduction of TN symptoms. Conclusions Utilizing this new method of intraoperative navigation with a unique surgical table in the upright position, surgeons may achieve precise head adjustments post-PGR. Head flexion has been postulated as a means of ensuring glycerol containment in Meckel's cave. This method can help standardize this procedure for future systematic studies on the importance of head positioning post-PGR.

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Section: Discussionmentioning

confidence: 94%

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia

Piper

Flores-Milan

Cruz

et al. 2023

J Neurol Surg B Skull Base

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“…As suggested by previous studies, the needle did have variations in the final position within Meckel's cave. 9,10 This procedure is often referred to as a retrogasserian rhizotomy, but the final position of the needle in these 22 specimens demonstrates that the retrogasserian portion of the trigeminal nerve is not always reached. This is supported by previous cadaveric studies showing a similar needle location in the medial middle fossa.…”

Section: Discussionmentioning

confidence: 99%

“…This is supported by previous cadaveric studies showing a similar needle location in the medial middle fossa. 9,10 Some studies find cerebrospinal fluid (CSF) flow to be a good predictor of success, suggesting a retrogasserian involvement of glycerol. However, given the discrepancies within the literature, a more thorough analysis of the final needle position using radiopaque dye could be beneficial to further adjudicate the ideal injection point and how glycerol immersion of the branches might have an important clinical correlate.…”

Section: Discussionmentioning

confidence: 99%

“…1,[3][4][5][6][7][8] While this is classically defined as a percutaneous retrogasserian glycerol rhizotomy, varying needle positions around the Gasserian ganglion (GG) have been reported, demonstrating a lack of clarity regarding the precise target area. 9,10 Moreover, variations between anatomic slopes surrounding the foramen ovale (FO) and their effect on glycerol distribution within the Meckel's Cave (MC) have not been published.…”

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confidence: 99%

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Clival-Meckel's Cave Angle: A Predictor of Glycerol Displacement in Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia

Piper,

George,

Gordon

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Percutaneous glycerol rhizotomy successfully treats trigeminal neuralgia although failure rates and durability of the procedure are variable. Some of this variability in clinical outcome might be due to egress of glycerol from Meckel's cave (MC) because of surgical positioning and individual patient anatomy. In this article, we quantitatively analyzed the anatomic variances that affect glycerol fluid dynamics to better predict patients more amenable for percutaneous glycerol injections. METHODS: Computed tomography imaging of 11 cadaveric heads was used to calculate bilateral Clival-Meckel's cave (CMC) and sella-temporal (ST) angles. Twenty-two cadaveric percutaneous injections of dyed glycerol into the Meckel's cave were performed using Härtel's approach, and the fluid movement was documented at prespecified intervals over 1 hour. The relationship between the angles and glycerol migration was studied. RESULTS: Specimens with basal cistern involvement by 60 minutes had significantly greater CMC angles (median [IQR]: basal cistern involvement = 74.5° [59.5°-89.5°] vs no basal cistern involvement = 58.0° [49.0°-67.0°]), U = 6.0, P < .001. This model may predict which patients will experience glycerol migration away from the Gasserian ganglion (area under the curve: 0.950, SE: 0.046, CI: 0.859-1.041, P < .001). Increased ST angle was associated with lateral flow of glycerol (rs = 0.639, P = .001), and CMC angle was associated with total area of dispersion (rs = −0.474, P = .026). CONCLUSION: Anatomic variation in skull base angles affects glycerol migration. Specifically, a more obtuse CMC angle was associated with a higher risk of posterior migration away from the Gasserian ganglion. This may be a reason for differing rates of surgical success. These results suggest that anterior head flexion for 60 minutes may prevent percutaneous glycerol rhizotomy failures and some patients with large CMC angles are more likely to benefit from postinjection head positioning. However, this clinical effect needs validation in vivo.

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“…It has been reported that magnetic resonance difusion tensor imaging (MR-DTI) can detect CNV lesions in TN patients [11][12][13][14][15]. Te success of treatment with radiofrequency is directly related to the area afected by the lesion [6]. Confrmation of probe insertion into the TGT is performed with a combination of electrophysiology tests and MR-DTI.…”

Section: Introductionmentioning

confidence: 99%

Effects of the MR-DTI Characteristics of the Trigeminal Ganglion Target on Radiofrequency Treatment in Patients with Trigeminal Neuralgia: A Retrospective Observational Clinical Study

Wang

Cheng

et al. 2023

Pain Research and Management

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Background. In the percutaneous treatment of trigeminal neuralgia (TN), the difficulty in accessing the foramen ovale (FO) has been widely recognized. However, the most efficient percutaneous treatment target is the so-called trigeminal ganglion target (TGT). We propose that the TGT in a puncture can be identified by magnetic resonance diffusion tensor imaging (MR-DTI). Objectives. To observe the effect of the characteristics of the TGT as detected by MR-DTI on percutaneous stereotactic radiofrequency rhizotomy (PSR) in TN patients. Methods. In our observational study, we preoperatively performed MR-DTI and/or 3D-CT for 48 TN patients, analyzed the characteristics of the TGT and/or FO, and designed appropriate surgical schemes for producing an accurate PSR trajectory according to these characteristics. The position and size of the TGT aided in adjusting the puncture angle and guiding the approach. Then, we successfully performed a customized PSR guided by the characteristics of the FO or TGT. During the postoperative and follow-up periods, we assessed the effect of treatment with pain scores and MR-DTI findings. Results. The characteristics of the TGT vary from patient to patient. We performed PSR with a single puncture guided by MR-DTI and 3D-CT in 16 patients, and only one patient required three punctures. All three of these punctures reached the FO target, as confirmed by intraoperative C-arm X-ray. We finally reached the TGT successfully after 2 additional attempts, confirming that the probe reached the TGT that accurately covered the pain territory with an electrophysiology test. The characteristics of the TGT were negatively correlated with the number of PSR punctures. Fewer complications occurred for PSRs guided by the TGT than for PSRs guided by the FO. Conclusions. The characteristics of the TGT are correlated with the number of punctures in the PSR. The application of MR-DTI for detecting the size of the TGT is an important step in predicting the difficulty of puncture. The PSR approach can be guided by the TGT and FO for TN patients who present with multiple adverse factors and thus may be beneficial in reducing the number of complications.

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

Cited by 6 publications

References 18 publications

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia

Clival-Meckel's Cave Angle: A Predictor of Glycerol Displacement in Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia

Effects of the MR-DTI Characteristics of the Trigeminal Ganglion Target on Radiofrequency Treatment in Patients with Trigeminal Neuralgia: A Retrospective Observational Clinical Study

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