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Percutaneous trigeminal rhizotomy in a biplane angiosuite: technical assessment

Abstract

Background Percutaneous trigeminal rhizotomy (PTR) uses fluoroscopic guidance to cannulate the foramen ovale for the treatment of trigeminal neuralgia.

Objective To describe the use of a high-resolution biplane neuroangiosuite for PTR and retrospectively to assess the performance of this technique.

Methods From 1990 through 2010, 67 PTRs were performed in 51 patients at our institution; 47 used the c-arm in the operating room (OR) and 20 used the biplane angiosuite. Hospital charts were reviewed for demographics, symptomatology, operative time, number of cannulation attempts, fluoroscopy time and pain outcome. Two-tailed univariate analyses were performed to compare the OR and angiosuite groups.

Results In 20 of 67 PTRs, biplane fluoroscopic guidance in the angiosuite was used. Variations in type of PTR, fluoroscopy technique and follow-up time barred meaningful comparison of these variables between OR and biplane groups. However, the biplane group had significantly fewer mean cannulation attempts (1 vs 2.2, p<0.001).

Conclusions High-resolution biplane neuroangiosuites offer a readily available alternative to ORs for PTR in the treatment of trigeminal neuralgia. Use of the biplane fluoroscopy machine was practical, safe and at least as effective as the use of the c-arm. It may also offer the advantages of a reduced number of cannulation attempts.

  • Technique
  • Peripheral nerve
  • Intervention
  • Cranial nerve

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