A multiarray mapping method to minimize morbidity from thermocoagulation as treatment of refractory trigeminal neuralgia

Surg Neurol. 2009 Apr;71(4):411-8; discussion 418. doi: 10.1016/j.surneu.2008.11.011.

Abstract

Background: Conventional percutaneous thermocoagulation of postgasserian fibers has shown high success rates, with significant residual morbidity.

Methods: This communication summarizes conclusions of multiple publications on our computerized mapping method and technique, and presents new data on short- and long-term results on trigeminal pain, including an actuarial analysis, complications.

Results: In TTN, 97.4% of 75 procedures produced initial pain relief without medication. In all, 84.7% of appropriate verbal responses were achieved by proper location of the needle at the chosen target, requiring an average of 1.45 tracts per procedure. Needle tip was located between 1 and 15 mm below the sellar floor in 97.0% of procedures and in an angle of 40 degrees to 80 degrees regarding the clivus profile projection in 99.1%. A 93% reduction of corneal analgesia and a 100% suppression of major dysesthesias and cranial nerve palsies were found.

Conclusion: We have shown a significant reduction of morbidity from percutaneous thermocoagulation of postgasserian fibers with similar short- and long-term results as those shown in 11 recently selected series. Strict adherence to all details of our new method and technique is essential. Future multiinstitutional studies are needed to confirm and enrich this small series.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Mapping / instrumentation
  • Brain Mapping / methods*
  • Computers
  • Electric Stimulation / instrumentation
  • Electric Stimulation / methods
  • Electrocoagulation / adverse effects
  • Electrocoagulation / methods*
  • Electrodiagnosis / instrumentation
  • Electrodiagnosis / methods
  • Female
  • Fluoroscopy / methods
  • Humans
  • Male
  • Microelectrodes / standards
  • Middle Aged
  • Monitoring, Intraoperative / instrumentation
  • Monitoring, Intraoperative / methods
  • Neuronavigation / instrumentation
  • Neuronavigation / methods
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control*
  • Transcutaneous Electric Nerve Stimulation / instrumentation
  • Transcutaneous Electric Nerve Stimulation / methods
  • Treatment Outcome
  • Trigeminal Ganglion / pathology
  • Trigeminal Ganglion / physiopathology
  • Trigeminal Ganglion / surgery*
  • Trigeminal Neuralgia / pathology
  • Trigeminal Neuralgia / physiopathology
  • Trigeminal Neuralgia / surgery*