Intraoperative CT-Guided Neuronavigation Enhances Radiofrequency Rhizotomy in Trigeminal Neuralgia

Overview

This study demonstrates that intraoperative CT combined with neuronavigation significantly improves the accuracy of foramen ovale cannulation during radiofrequency rhizotomy for trigeminal neuralgia. Nearly half of the cases required adjustment from conventional landmark-based entry points, highlighting anatomical variability.

Background

Trigeminal neuralgia is a debilitating facial pain disorder often treated with radiofrequency rhizotomy targeting the trigeminal nerve via the foramen ovale. Traditional fluoroscopy-guided approaches rely on surface landmarks but are challenged by anatomical variations, leading to multiple needle passes and increased risk. Intraoperative computed tomography (iCT) with neuronavigation offers real-time imaging and trajectory planning to improve procedural precision and safety.

Data Highlights

Key Findings

• Conventional surface landmark entry points were suboptimal in 47.8% of cases, necessitating trajectory adjustments.
• Adjustments predominantly involved an inferior shift, either inferolateral or inferomedial, to accommodate anatomical variations.
• Mean lateral displacement was 3.75 mm and mean inferior displacement was 14.65 mm from the landmark-based entry point.
• Intraoperative CT and neuronavigation enabled successful foramen ovale cannulation in all patients without complications.
• Neuronavigation facilitated preprocedural planning and real-time trajectory correction, reducing multiple punctures and procedural risks.

Clinical Implications

Incorporating intraoperative CT with neuronavigation into radiofrequency rhizotomy for trigeminal neuralgia enhances procedural accuracy by tailoring cannulation paths to individual anatomy. This approach minimizes patient discomfort and reduces the risk of complications associated with multiple needle passes. Clinicians should consider neuronavigation-guided techniques especially in cases where anatomical variations are suspected.

Conclusion

Intraoperative CT-based neuronavigation is a safe and effective adjunct to conventional radiofrequency rhizotomy, improving cannulation success by accommodating anatomical variability. This technique represents a valuable advancement in the minimally invasive treatment of trigeminal neuralgia.

References

1. Article Source 2024 -- Intraoperative CT-Based Neuronavigation for Radiofrequency Rhizotomy in Trigeminal Neuralgia