Improved method of percutaneous approach to the trigeminal ganglion and sensory root
Keywords:trigeminal nerve, neuralgia, trigeminal neuralgia, neurosurgical treatment, percutaneous approach
Objective. Improvement of the percutaneous approach to the trigeminal ganglion and sensory root through the foramen ovale using modern neuroimaging techniques, which will improve the results of puncture neurosurgical treatment of patients with drug-resistant forms of trigeminal neuralgia.
Materials and methods. From May 2013 to June 2019, 26 patients were under our supervision, out of which there were 8 men and 18 women, aged from 32 to 88 (average age 62.48 ± 11.47) years with refractory forms of trigeminal neuralgia with severe pain syndrome. They underwent 33 interventions by percutaneous approach through the foramen ovale using cone-beam computed tomography (CBCT). The disease duration ranged from 1 to 28 (on average, 7.58 ± 4.83) years. The pain severity on a visual analogue scale (VAS) ranged from 7.1 to 10 (on average, 8.86 ± 0.65) cm.
Results. We have developed a method of percutaneous approach to the trigeminal ganglion and sensory root, taking into account the individual anatomical features of the skull and face of each patient based on preoperative modelling using CBCT with 3D modelling. The method allows to accurately determine the most optimal puncture point on the face, as well as reliable topographic bone landmarks, the angles of puncture needle directions from the puncture point in three planes and the necessary distances. This approach helps to facilitate the procedure, reduce its invasiveness and duration, ensures the successful implementation of puncture access through the foramen ovale.
Conclusions. Based on the method developed by us, we managed to overcome the technical difficulties of percutaneous approach through the foramen ovale, which were due to the anatomical features of the base of the skull and pyramid of the temporal bone and the cicatricial adhesion on the outer surface of the base of the skull.
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