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Original research
Usefulness of flat detector CT (FD-CT) with biplane fluoroscopy for complication avoidance during radiofrequency thermal rhizotomy for trigeminal neuralgia
  1. Hariharan Venkat Iyer Easwer1,
  2. Nilay Chatterjee2,
  3. Ajith Thomas3,
  4. Kannath Santhosh4,
  5. Kapilamoorthy Tirur Raman4,
  6. Rupa Sridhar5
  1. 1Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
  2. 2Department of Anesthesia and ICU, Khoula Hospital, Muscat, Sultanate of Oman
  3. 3Division of Neurosurgery, Section of Cerebrovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  4. 4Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
  5. 5Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
  1. Correspondence to Dr Hariharan Venkat Iyer Easwer, Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Medical College Campus, Trivandrum 695011, Kerala, India; dreaswer{at}


Introduction Trigeminal neuralgia (TN) is characterized by episodes of shooting pain in the areas innervated by one or more divisions of the trigeminal nerve. The initial treatment of TN is with drugs but the increased frequency and intensity of the neuralgic episodes often force the patient to seek alternative therapies. Microvascular decompression (MVD) and radiofrequency thermal lesioning of trigeminal rootlets (RFTR) offer close to the best results for TN. MVD has the disadvantage of being an open surgical procedure with its attendant risks and longer hospital stay, whereas RFTR is a short, ‘day-care’ procedure. However this latter procedure involves positioning of the RF needle in the area behind the trigeminal ganglion through the foramen ovale, which can pose significant challenges.

Objective To use the fluoroscopic support of a biplane catheter laboratory to access the foramen, and flat detector CT to confirm the location of the tip of the RF needle in the optimal position.

Methods Fifty-three patients with TN underwent RFTR under local anesthesia with conscious sedation.

Results All patients reported pain relief with hypesthesia over the offending trigeminal division. In seven patients the needle tip required repositioning according to the CT images. Two patients each had loss of corneal reflex and abducens nerve palsy after the procedure. No other complications were seen.

Conclusions The superior view in two planes coupled with the anatomical confirmation of the position of the needle tip in the Meckel's cave during the rhizotomy reduces the need for multiple passages of the needle to access the foramen ovale and achieves accurate needle tip positioning. The technique increases the safety and precision of such treatments and helps to manage potential complications.

  • Technique
  • Technology
  • CT
  • Lesion
  • Intervention

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