Radiation exposure and safety in low-dose CT-guided glycerol rhizotomy for trigeminal Neuralgia outside the operating room.

Acta Neurochir (Wien)

Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital, Pilsen, Czech Republic.

Published: November 2024

Background: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure.

Methods: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group.

Results: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years.

Conclusion: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584485PMC
http://dx.doi.org/10.1007/s00701-024-06364-9DOI Listing

Publication Analysis

Top Keywords

percutaneous rhizotomy
12
ct-guided group
12
radiation exposure
8
low-dose ct-guided
8
rhizotomy gasserian
8
gasserian ganglion
8
fluoroscopy group
8
group median
8
median effective
8
effective dose
8

Similar Publications

Background: People with Multiple Sclerosis (MS) have a 20-fold higher risk of developing trigeminal neuralgia compared to the general population. Treating trigeminal neuralgia in these patients is particularly challenging due to reduced tolerance and increased side effects from medications. When no neurovascular conflict exist, percutaneous treatments are usually the first option after drug therapy.

View Article and Find Full Text PDF

Radiation exposure and safety in low-dose CT-guided glycerol rhizotomy for trigeminal Neuralgia outside the operating room.

Acta Neurochir (Wien)

November 2024

Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital, Pilsen, Czech Republic.

Background: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure.

Methods: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken.

View Article and Find Full Text PDF

Purpose: Percutaneous lesioning-techniques for treating refractory Trigeminal Neuralgias not amenable to Micro-Vascular Decompression remain useful in neurosurgical practice. Success, avoidance of complications and reduction of side-effects depend on the accurate location of the lesion-maker especially for Radio-Frequency-Thermo-Rhizotomy (RF-Th-Rh). Added to X-ray-guidance, Intra-Operative Neurophysiology can be of significant help to achieve optimal accuracy of the surgery.

View Article and Find Full Text PDF
Article Synopsis
  • - Trigeminal neuralgia (TN) is a painful condition treated through various surgical methods, including microvascular decompression (MVD) and stereotactic radiosurgery such as Gamma Knife.
  • - MVD offers substantial long-term relief but has varying recurrence rates, while GKRS provides good initial pain relief but may require repeat procedures over time.
  • - The review stresses the need for personalized treatment plans and careful patient selection to improve outcomes, as each surgical option has its own risks and effectiveness depending on the patient's specific situation.
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!