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.

Department of Imaging Methods Faculty of Medicine in Pilsen Charles University University Hospital Pilsen Czech Republic

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

Department of Neurosurgery Faculty of Medicine University of Ostrava University Hospital Ostrava Czech Republic

Department of Radiological Physics Faculty of Medicine in Pilsen Charles University University Hospital Pilsen Czech Republic

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Arishima H, Kawajiri S, Arai H, Higashino Y, Kodera T, Kikuta K (2016) Percutaneous glycerol rhizotomy for trigeminal Neuralgia using a Single-Plane, flat panel detector Angiography System: technical note. Neurol Med Chir (Tokyo) 56:257–263. 10.2176/nmc.tn.2015-0286 PubMed PMC

Bohnstedt BN, Tubbs RS, Cohen-Gadol AA (2012) The use of intraoperative navigation for percutaneous procedures at the skull base including a difficult-to-access foramen ovale. Neurosurgery 70:177–180. 10.1227/NEU.0b013e3182309448 PubMed

Chen HI, Lee JY (2010) The measurement of pain in patients with trigeminal neuralgia. Clin Neurosurg 57:129–133 PubMed

Easwer HV, Chatterjee N, Thomas A, Santhosh K, Raman KT, Sridhar R (2016) Usefulness of flat detector CT (FD-CT) with biplane fluoroscopy for complication avoidance during radiofrequency thermal rhizotomy for trigeminal neuralgia. J Neurointerv Surg 8:830–833. 10.1136/neurintsurg-2015-011738 PubMed

Elmaraezy A, Ebraheem Morra M, Tarek Mohammed A, Al-Habaa A, Elgebaly A, Abdelmotaleb Ghazy A, Khalil AM, Tien Huy N, Hirayama K (2017) Risk of cataract among interventional cardiologists and catheterization lab staff: a systematic review and meta-analysis. Catheter Cardiovasc Interv 90:1–9. 10.1002/ccd.27114 PubMed

Gusmao S, Oliveira M, Tazinaffo U, Honey CR (2003) Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy. Technical note. J Neurosurg 99:785–786. 10.3171/jns.2003.99.4.0785 PubMed

Hakanson S (1981) Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9:638–646. 10.1227/00006123-198112000-00005 PubMed

Iwanaga J, Badaloni F, Laws T, Oskouian RJ, Tubbs RS (2018) Anatomic study of Extracranial needle trajectory using Hartel technique for Percutaneous Treatment of Trigeminal Neuralgia. World Neurosurg 110:e245–e248. 10.1016/j.wneu.2017.10.140 PubMed

Kaplan M, Erol FS, Ozveren MF, Topsakal C, Sam B, Tekdemir I (2007) Review of complications due to foramen ovale puncture. J Clin Neurosci 14:563–568. 10.1016/j.jocn.2005.11.043 PubMed

Kondziolka D, Lunsford LD (2005) Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia: technique and expectations. Neurosurg Focus 18:E7. 10.3171/foc.2005.18.5.8 PubMed

Kouzounias K, Lind G, Schechtmann G, Winter J, Linderoth B (2010) Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia. J Neurosurg 113:486–492. 10.3171/2010.1.JNS091106 PubMed

Lin EC (2010) Radiation risk from medical imaging. Mayo Clin Proc 85:1142–1146. 10.4065/mcp.2010.0260. (quiz 1146) PubMed PMC

Liu H, Xu L, Zhao W (2022) Puncture approaches and guidance techniques of radiofrequency thermocoagulation through foramen Ovale for primary trigeminal neuralgia: systematic review and meta-analysis. Front Surg 9. 10.3389/fsurg.2022.1024619 PubMed PMC

McCollough CH, Bushberg JT, Fletcher JG, Eckel LJ (2015) Answers to common questions about the Use and Safety of CT scans. Mayo Clin Proc 90:1380–1392. 10.1016/j.mayocp.2015.07.011 PubMed

Peris-Celda M, Graziano F, Russo V, Mericle RA, Ulm AJ (2013) Foramen Ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications. J Neurosurg 119:1176–1193. 10.3171/2013.1.JNS12743 PubMed

Piper K, Smith T, Saez-Alegre M, Jean W, Bezchlibnyk Y, Van Loveren H (2024) Does Head Positioning after Percutaneous glycerol rhizotomy for trigeminal Neuralgia Matter? World Neurosurg 181:e447–e452. 10.1016/j.wneu.2023.10.078 PubMed

Schmidt BT, Pun CD, Lake WB, Resnick DK (2020) Computed Tomography Guidance for Percutaneous glycerol rhizotomy for trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 19:E117–E121. 10.1093/ons/opz400 PubMed

SohrabiAsl M, Shirani M, Jahanbakhshi A, Iranmehr A (2024) Efficacy and challenges: minimally invasive procedures for trigeminal Neuralgia treatment in multiple sclerosis - A systematic review and Meta-analysis. Stereotact Funct Neurosurg 102:156–168. 10.1159/000538516 PubMed

Telischak NA, Heit JJ, Campos LW, Choudhri OA, Do HM, Qian X (2018) Fluoroscopic C-Arm and CT-Guided selective Radiofrequency ablation for Trigeminal and Glossopharyngeal Facial Pain syndromes. Pain Med 19:130–141. 10.1093/pm/pnx088 PubMed

Texakalidis P, Xenos D, Tora MS, Wetzel JS, Boulis NM (2019) Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. Clin Neurol Neurosurg 182:112–122. 10.1016/j.clineuro.2019.05.011 PubMed

Thatikunta M, Eaton J, Nuru M, Nauta HJ (2020) Intraoperative CT for neuronavigation guidance and confirmation of foramen ovale cannulation for glycerol trigeminal rhizotomy: a technical report and case series. Cureus 12:e8100. 10.7759/cureus.8100 PubMed PMC

Tubbs RS, Dixon J, Loukas M, Cohen-Gadol AA (2010) Regional vascular relationships to the foramen ovale: an anatomical study with application to approaches to the external skull base with an emphasis on transcutaneous procedures for the treatment of trigeminal neuralgia. J Neurosurg 113:493–497. 10.3171/2010.3.JNS091454 PubMed