title: Usefulness of flat detector CT (FD-CT) with biplane fluoroscopy for complication avoidance during radiofrequency thermal rhizotomy for trigeminal neuralgia.
abstract: BACKGROUND
  Trigeminal neuralgia (TN) is characterized by episodes of shooting pain in the areas innervated by one or more divisions of the trigeminal nerve. The initial treatment of TN is with drugs but the increased frequency and intensity of the neuralgic episodes often force the patient to seek alternative therapies. Microvascular decompression (MVD) and radiofrequency thermal lesioning of trigeminal rootlets (RFTR) offer close to the best results for TN. MVD has the disadvantage of being an open surgical procedure with its attendant risks and longer hospital stay, whereas RFTR is a short, 'day-care' procedure. However this latter procedure involves positioning of the RF needle in the area behind the trigeminal ganglion through the foramen ovale, which can pose significant challenges.
  
  
  OBJECTIVE
  To use the fluoroscopic support of a biplane catheter laboratory to access the foramen, and flat detector CT to confirm the location of the tip of the RF needle in the optimal position.
  
  
  METHODS
  Fifty-three patients with TN underwent RFTR under local anesthesia with conscious sedation.
  
  
  RESULTS
  All patients reported pain relief with hypesthesia over the offending trigeminal division. In seven patients the needle tip required repositioning according to the CT images. Two patients each had loss of corneal reflex and abducens nerve palsy after the procedure. No other complications were seen.
  
  
  CONCLUSIONS
  The superior view in two planes coupled with the anatomical confirmation of the position of the needle tip in the Meckel's cave during the rhizotomy reduces the need for multiple passages of the needle to access the foramen ovale and achieves accurate needle tip positioning. The technique increases the safety and precision of such treatments and helps to manage potential complications.
authors.affiliation: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Hariharan Venkat Iyer
authors.initials: HV
authors.lastname: Easwer
authors.affiliation: Department of Anesthesia and ICU, Khoula Hospital, Muscat, Sultanate of Oman.
authors.forename: Nilay
authors.initials: N
authors.lastname: Chatterjee
authors.affiliation: Division of Neurosurgery, Section of Cerebrovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Ajith
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Kannath
authors.initials: K
authors.lastname: Santhosh
authors.affiliation: Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Kapilamoorthy Tirur
authors.initials: KT
authors.lastname: Raman
authors.affiliation: Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Rupa
authors.initials: R
authors.lastname: Sridhar
mesh_terms: D020222:Abducens Nerve Injury / Q000209:etiology; D000368:Aged; D000772:Anesthesia, Local; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D016292:Procedural Sedation; D003316:Corneal Diseases / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D054085:Foramen Ovale / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009339:Needles; D038361:Neuronavigation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D019051:Rhizotomy / Q000009:adverse effects* / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: CT; Intervention; Lesion; Technique; Technology