Percutaneous Trigeminal Rhizotomy in a Biplane Angiosuite

Jonathan Jay Stone, MD1, Katherine Rose1, Zeguang Ren, MD1, Babak Jahromi, MD, PhD1

1Rochester, NY United States

Keywords: rhizotomy, technique, percutaneous, image guidance, outcome

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     Percutaneous trigeminal rhizotomy remains a mainstay treatment for trigeminal neuralgia. This technique utilizes fluoroscopic guidance to cannulate the foramen ovale and can be executed in a variety of hospital locations.
     This abstract describes the unique use of the angiography suite, which provides high-resolution biplane fluoroscopy that may shorten operative times and improve pain relief.
     A total of 67 procedures were performed in 51 patients; 46 were completed using the c-arm in the operating room and 21 utilized the angiography suite.
     A retrospective study was performed at Strong Memorial Hospital to analyze percutaneous trigeminal rhizotomies performed from 1990 through 2010. Hospital charts were reviewed for demographics, symptomatology, operative times, number of cannulation attempts, and pain outcome. These variables were compared between cases performed in the operating room and in the angiography suite.
     The demographic and preoperative symptoms were similar between the two groups. Although there was a trend for shorter operative times in the angiography suite (55 vs 69 minutes), the comparison did not reach statistical significance (p = 0.087). The angiography group also had a significant decrease in the mean number of cannulation attempts (1 vs 2.3, p <0.001). Both groups had similar follow up times; however, the angiography group was less likely to have pain at follow-up (12% vs 47%, p < 0.001).
     This is a retrospective study.
     The angiography suite provides readily available high-resolution biplane fluoroscopy for the treatment of trigeminal neuralgia.
     Utilizing this technology can potentially reduce operative time, decrease complications through more accurate needle trajectory and improve postoperative pain relief.


Project Roles:

J. Stone (), K. Rose (), Z. Ren (), B. Jahromi ()