Cone Beam CT With Flat Panel Detector and Biplane Fluoroscopy-Guided Percutaneous Trigeminal Nerve Rhizotomy Using Three-Dimensional Needle Trajectory Planning

Dylan T Cohen; Ilya Bragin; Roy Hwang; Martin Oselkin

doi:10.7759/cureus.25538

Cone Beam CT With Flat Panel Detector and Biplane Fluoroscopy-Guided Percutaneous Trigeminal Nerve Rhizotomy Using Three-Dimensional Needle Trajectory Planning

Cureus. 2022 May 31;14(5):e25538. doi: 10.7759/cureus.25538. eCollection 2022 May.

Authors

Dylan T Cohen^{1

2

3}, Ilya Bragin^{2

3}, Roy Hwang⁴, Martin Oselkin⁵

Affiliations

¹ Neurology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA.
² Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA.
³ Neurology, St. Luke's University Health Network, Bethlehem, USA.
⁴ Neurosurgery, St. Luke's University Health Network, Bethlehem, USA.
⁵ Neurosurgery/Interventional Neuroradiology, St. Luke's University Health Network, Bethlehem, USA.

Abstract

Trigeminal-mediated pain disorders can be devastating for patients refractory to medical therapy. Gasserian ganglion blocks and percutaneous trigeminal rhizotomy have been used with success to treat these patients, however, serious complication risks include facial hematoma, cranial nerve palsy, and stroke. Cone beam CT, combined with fluoroscopy and needle navigation has been shown to decrease needle pass rates, procedure time, radiation exposure, and complications in multiple interventional radiology procedures, but hitherto has not been utilized for Gasserian ganglion interventions. Here, we present two cases of trigeminal-mediated pain successfully treated via cone beam CT combined fluoroscopy and needle navigation.

Keywords: biplane fluoroscopy; cone-beam computed tomography (cbct); gasserian ganglion; glycerol rhizotomy; meckel's cave; needle trajectory planning; neuronavigation; percutaneous radiofrequency rhizotomy; trigeminal neuralgia; trigeminal rhizotomy.