title: Comparing Radiation Dose from Conventional Fluoroscopy to Intraoperative Cone Beam CT (O-arm) during Percutaneous Lesioning Procedures of the Gasserian Ganglion.
abstract: BACKGROUND
  The use of intraoperative CT-guidance during the percutaneous treatment of trigeminal neuralgia has become increasingly popular due to the greater ease of foramen ovale cannulation and decreased procedure times. Concerns regarding radiation dose to the patient, however, remain unaddressed. We sought to compare the emitted radiation dose from fluoroscopy with intraoperative CT for these procedures.
  
  
  METHODS
  A retrospective review of percutaneous lesioning procedures for trigeminal neuralgia performed between 2010 until 2012 at our institution was conducted and radiation doses to the patient were recorded. We subsequently simulated four separate percutaneous trigeminal rhizotomies using the O-arm intraoperative CT (Medtronics, Minneapolis, MN, USA) to cannulate the foramen ovale bilaterally in two formalin-fixed cadaver heads.
  
  
  RESULTS
  Seventeen successful percutaneous treatments for trigeminal neuralgia were performed during the study period. Eleven procedures containing complete records were included in the final analysis. For procedures using fluoroscopy, the mean dosage was 15.2 mGys (range: 1.15 - 47.95, 95% CI 7.34 - 22.99). Radiation dosage from the O-arm imaging system was 16.55 mGy for all four cases. An unequal variance t-test did not reach statistical significance (p=0.42).
  
  
  CONCLUSIONS
  We did not observe a significant difference in radiation dose delivered to subjects when comparing CT-guided foramen ovale cannulation relative to fluoroscopy for percutaneous lesioning of the Gasserian ganglion. Additional study is required under operational settings.
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Sohum
authors.initials: S
authors.lastname: Desai
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Vishal J
authors.initials: VJ
authors.lastname: Patel
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Rishi R
authors.initials: RR
authors.lastname: Lall
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Daniel
authors.initials: D
authors.lastname: Branch
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Achal P
authors.initials: AP
authors.lastname: Patel
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Randall Z
authors.initials: RZ
authors.lastname: Allison
authors.affiliation: Neurosurgey, Swedish Neuroscience Institute.
authors.forename: David
authors.initials: D
authors.lastname: Paulson
authors.affiliation: Division of Neurosurgery, University of Texas Medical Branch at Galveston.
authors.forename: Juan R
authors.initials: JR
authors.lastname: Ortega-Barnett
keywords: cone beam ct; fluoroscopy; percutaneous trigeminal rhizotomy; radiation dose; trigeminal neuralgia