Neuronavigated percutaneous gasserian radiofrequency thermorhizotomy for trigeminal neuralgia: how I do it

Abstract

Background: Radiofrequency thermorhizotomy (TRZ) is an established treatment for trigeminal neuralgia (TN). TRZ can result risky and painful in a consistent subset of patients, due to the need to perform multiple trajectories, before a successful foramen ovale cannulation. Moreover, intraoperative x-rays are required.

Method: TRZ has been performed by using a neuronavigated stylet, before trajectory planning on a dedicated workstation.

Conclusion: Navigated-TRZ (N-TRZ) meets the expectations of a safer and more tolerable procedure due to the use of a single trajectory, avoiding critical structures. Moreover, N-TRZ is x-ray free. Efficacy outcomes are similar to those reported in literature.

Keywords: Foramen ovale; Gasser's ganglion; Magnetic neuronavigation; Pain; Percutaneous; Radiofrequency; Thermorhizotomy; Trigeminal ganglion; Trigeminal nerve; Trigeminal neuralgia.