Angle and Distance Analysis on Percutaneous Trigeminal Radiofrequency Rhizotomy for Trigeminal Neuralgia

Abstract

Objectives: Percutaneous trigeminal radiofrequency rhizotomy (RFTC) is a safe and effective intervention for trigeminal neuralgia treatment. Hartel’s approach enables the surgeon to perform percutaneous foramen ovale interventions by using anatomical landmarks. We aimed to analyze the study results to verify the electrode angles and distances between the indicated anatomical landmark points. Materials and Methods: Between 2019 and 2022, 119 out of 121 patients evaluated who underwent RFTC at the neurosurgery department. We retrospectively analyzed the electrode angles and distances radiologically and postoperative pain relief. The RFTC in our study included four parameters: the distance between petrous apex (PA) and the needle tip reaching the Gasserian ganglion in the sagittal plane, the distance betwee PA and the dorsum sellae in the sagittal plane,the ratio of the first parameter to the second parameter, and last measurement was the angle between PA and the dorsum sella line and the line depicting the needle pathway. Results: There was a statistically significant difference in the PA-dorsum sellae distances between the successful and unsuccessful procedure groups (p<0.05). There was no statistically significant difference in the other three parameters between the two groups. The ratio of the two procedural distances was investigated to define the relation between the parameters and the success of the procedure. Receiver operating characteristic analysis was performed between PA-needle tip distance and PA-dorsum sellae distance Youden analysis of the area under the curve parameters had a cut-off value of <0.20. Conclusion: The success of the RFTC procedure is inversely proportional with the ratio of the PA-needle tip distance to the PA-dorsum sella distance (0.20 coefficient). This ratio is an easy-to-define, reliable, and simple parameter to predict success of the intervention. Since the number of studies on the RFTC method and its radiological interpretation is limited, more cadaver and clinical studies should be performed to avoid damagin neighboring structures, increase the success rate, and determine safe penetration points and angles. Key Words: Trigeminal Neuralgia, Percutaneous Trigeminal Radiofrequency Rhizotomy, Foramen Ovale, Trigeminal Ganglion

Keywords

• Trigeminal Neuralgia
• Percutaneous Trigeminal Radiofrequency Rhizotomy
• Foramen Ovale
• Trigeminal Ganglion

Trigeminal Nevraljide Uygulanan Perkütan Trigeminal Radyofrekans Rizotomi İşleminde Açı ve Uzaklık Ölçümlerinin Analizi

Abstract

Amaç: Perkütan trigeminal radyofrekans rizotomi (RFTK), trigeminal nevralji için güvenli ve etkili bir müdahaledir. Hartel yaklaşımı ile cerrahın anatomik işaretler kullanarak perkütan foramen ovale müdahaleleri gerçekleştirmesi sağlanır. Bu çalışmada RFTK yapılan hastalarda elektrot açılarını ve mesafelerini radyolojik olarak ve postoperatif ağrı durumunu retrospektif olarak incelenmiştir. Gereç ve Yöntem: Ocak 2019-Aralık 2022 tarihleri arasında nöroşirürji polikliniğinde RFTK uygulanan ve çalışmaya alınan toplam 121 hastadan 119’u çalışmaya alındı. Elektrot açılarını ve anatomik işaretler arasındaki mesafeleri analiz edilerek RFTK yapılan hastalarda dört parametre incelendi: Sagittal düzlemde petröz apeks (PA) ile Gasser ganglionuna ulaşan iğne ucu arasındaki mesafe, sagittal düzlemde PA ile dorsum sella arasındaki mesafe, ilk parametrenin ikinci parametreye oranı ve son olarak, PA ile dorsum sellae arasındaki hat ile iğne yolunun hattı arasındaki açı .Bulgular: Başarılı ve başarısız işlem grupları arasında PA-dorsum sella mesafelerinde istatistiksel olarak anlamlı bir fark vardı (p<0,05). Diğer üç parametrede iki grup arasında istatistiksel olarak anlamlı fark yoktu. Parametreler ve prosedürün başarısı arasındaki ilişkiyi tanımlamak için iki prosedür mesafesinin oranı araştırıldı. PA-iğne ucu mesafesi ile PA-dorsum sella mesafesi arasında alıcı işletim karakteristiği analizi yapıldı. Eğri parametreleri altındaki alanın Youden analizi <0,20’lik bir eşik değerine sahip olduğu görüldü. Sonuç: PA-iğne ucu mesafesinin PA-dorsum sellae mesafesine oranı azaldıkça (0,20 katsayısı) RFTC prosedürünün başarısı artar. Bu oran tanımlanması kolay, güvenilir ve basit bir parametredir ve oranın girişimin başarı öngörüsüne katkısı olmaktadır. RFTK yöntemi ve radyolojik yorumu ile ilgili çalışmaların sayısı sınırlı olduğundan, komşu hayati yapılara zarar vermemek, başarı oranını yükseltmek ve güvenli penetrasyon noktalarını ve açılarını belirlemek için daha fazla kadavra ve klinik çalışma yapılmalıdır. Anahtar Kelimeler: Trigeminal Nevralji, Perkütan Trigeminal Radyofrekans Rizotomi, Foramen Ovale, Trigeminal Gangliyon

Keywords

• Trigeminal Nevralji
• Perkütan Trigeminal Radyofrekans Rizotomi
• Foramen Ovale
• Trigeminal Gangliyon

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