Computed Tomography Guidance for Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia

2019 ◽  
Vol 19 (2) ◽  
pp. E117-E121
Author(s):  
Bradley T Schmidt ◽  
Conrad D Pun ◽  
Wendell B Lake ◽  
Daniel K Resnick
Keyword(s):  
Computed Tomography ◽  
Trigeminal Neuralgia ◽  
Radiation Exposure ◽  
Skull Base ◽  
Ct Guidance ◽  
Foramen Ovale ◽  
Ct Scanner ◽  
Ct Guided ◽  
Needle Position ◽  
Scout Image

Abstract Background Percutaneous glycerol rhizotomy (PGR) is a well-described treatment for trigeminal neuralgia; however, the technique in using surface landmarks and fluoroscopy has not drastically changed since being first introduced. In this paper, we describe a protocol for PGR using computed tomography (CT) guidance based on an experience of over 7 yr and 200 patients. Objective To introduce an approach for PGR using CT guidance and, in doing so, demonstrate possible benefits over the traditional fluoroscopic technique. Methods Using a standard CT scanner, patients are placed supine with head in extension. Barium paste and a CT scout image are used to identify and plan a trajectory to the foramen ovale. A laser localization system built into the CT scanner helps to guide placement of the spinal needle into the foramen ovale. The needle position in the foramen is confirmed with a short-sequence CT scan. Results CT-guided PGR provides multiple benefits over standard fluoroscopy, including improved visualization of the skull base and significant reduction in radiation exposure to the surgeon and staff. Side benefits include improved procedure efficiency, definitive imaging evidence of correct needle placement, and potentially increased patient safety. We have had no significant complications in over 200 patients. CONCLUSION CT-guided PGR is a useful technique for treating trigeminal neuralgia based on better imaging of the skull base, better efficiency of the procedure, and elimination of radiation exposure for the surgeon and staff compared to traditional fluoroscopic based techniques.

scholarly journals Evaluation of Anatomoradiological Findings on Trigeminal Neuralgia Patients Using Computed Tomography and Cone-Beam Computed Tomography

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 73
Author(s):  
Seçil Aksoy ◽  
Arzu Sayın Şakul ◽  
Durmuş İlker Görür ◽  
Bayram Ufuk Şakul ◽  
Kaan Orhan
Keyword(s):  
Computed Tomography ◽  
Trigeminal Neuralgia ◽  
Cone Beam Ct ◽  
Median Plane ◽  
Cone Beam ◽  
Foramen Ovale ◽  
Percutaneous Procedures ◽  
The Right ◽  
And Control ◽  
Supraorbital Foramen

The study aimed to establish and evaluate anatomoradiological landmarks in trigeminal neuralgia patients using computed tomography (CT) and cone-beam CT. CT images of 40 trigeminal neuralgia (TN) and 40 healthy individuals were retrospectively analyzed and enrolled in the study. The width and length of the foramen rotundum (FR), foramen ovale (FO), foramen supraorbitale, and infraorbitale were measured. The distances between these foramen, between these foramen to the median plane, and between the superior orbital fissure, FO, and FR to clinoid processes were also measured bilaterally. Variations were evaluated according to groups. Significant differences were found for width and length of the foramen ovale, length of the foramen supraorbitale, and infraorbitale between TN and control subjects (p < 0.05). On both sides, FO gets narrower and the length of the infraorbital and supraorbital foramen shortens in the TN group. In most of the control patients, the plane which passes through the infraorbital and supraorbital foramen intersects with impression trigeminale; 70% on the right-side, and 67% in the left-side TN groups. This plane does not intersect with impression trigeminale and deviates in certain degrees. The determination of specific landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures in trigeminal neuralgia patients.

scholarly journals Role of Advanced Imaging in Gasserian Neurolysis in Head and Neck Cancer with Skull Base Invasion

2019 ◽  
Vol 05 (02) ◽  
pp. 086-088
Author(s):  
Bablesh Mahawar ◽  
Vivek Mahawar
Keyword(s):  
Head And Neck ◽  
Skull Base ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Lateral Approach ◽  
Foramen Ovale ◽  
Trigeminal Neuropathy ◽  
Ct Guided ◽  
Numerical Rating ◽  
Left Maxillary Sinus

Abstract Introduction A 46-year-old female with a postoperated case of carcinoma left upper alveolus diagnosed in March 2018, with recurrence, was presented to the hospital. She had lancinating pain around left facial pain, which gradually increased over 10 months. On numerical rating scale, her pain was 9 on 10. Her chief complaint was continuous dull pain above and below the left eye, with sudden, brief, paroxysmal episodes of intolerable burning and stabbing type of pain. This episodic pain lasted for 30 to 40 seconds. On examination, she had left III, V, and VI nerve palsy with ptosis. Magnetic resonance imaging of face and brain revealed an enhancing infiltrative mass in left maxillary sinus extending to base of skull. Clinical diagnosis of left-sided painful trigeminal neuropathy in ophthalmic and maxillary (V1 and V2) division was made. Aim This study was aimed to relieve patient’s pain and improve her quality of life. Materials and Methods Gasserian neurolysis was successfully completed under computed tomography (CT) guidance because of the distortion of skull base anatomy using a 22-G, 10-cm long spinal needle directed towards foramen ovale (FO) from a lateral approach. Conclusion CT-guided identification of foramen ovale can be labeled as a novel method of locating FO for precise percutaneous techniques to the trigeminal ganglion in advanced head and neck cancers.

scholarly journals Computed Tomography-Guided Bronchoscopy With an Ultrathin Fiberscope

1996 ◽  
Vol 2 (4) ◽  
pp. 229-232 ◽  
Author(s):  
Toshiaki Kobayashi ◽  
Kayako Shimamura ◽  
Kohzoh Hanai ◽  
Masahiro Kaneko
Keyword(s):  
Computed Tomography ◽  
Pulmonary Function ◽  
Endoscopic Examination ◽  
Open Lung Biopsy ◽  
Ct Guidance ◽  
Ct Guided ◽  
Open Lung ◽  
Examination Method ◽  
The Right ◽  
Poor Pulmonary Function

Bronchoscopy was performed under computed tomography (CT) guidance using an ultrathin fiberscope in a patient with a fluoroscopically invisible lesion that was visualized by CT in the right S8 and with poor pulmonary function. Under local anesthesia, the ultrathin fiberscope (3 mm in diameter) was inserted close to the lesion (1.5 mm in diameter) under direct visual guidance, and a brush was inserted into the lesion under CT guidance. Cytologic specimens obtained by the brush and washing revealed adenocarcinoma. This is the first report of CT-guided bronchoscopy, which is a new examination method for peripheral small lung lesions and is a less invasive examination than either endoscopic examination with a conventional bronchoscope or open lung biopsy, especially for those with poor pulmonary function.

scholarly journals Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology

2021 ◽  
Author(s):  
Timo C. Meine ◽  
Jan B. Hinrichs ◽  
Thomas Werncke ◽  
Saif Afat ◽  
Lorenz Biggemann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
The Self ◽  
Ct Guidance ◽  
Spatial Skills ◽  
Ct Guided ◽  
Needle Path ◽  
Manual Skills ◽  
Level Of Training ◽  
Guided Puncture ◽  
Navigation Software

Purpose Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT). Methods In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT’s level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments. Results RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (p = 1), angiographic experience (p = 0.415), and number of ultrasound-guided puncture procedures (p = 0.483), CT-guided puncture procedures (p = 0.934), and CACT-guided puncture procedures (p = 0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (p < 0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (p = 0.719). However, in the case of CACT, the second puncture was significantly faster (p = 0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (p = 0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: p = 0.130; CACT: p = 0.391). The self-assessment of manual skills did not correlate with puncture deviation (p = 0.059) and puncture duration (p = 0.158). The self-assessed spatial skills correlated positively with puncture deviation (p = 0.011) but not with puncture duration (p = 0.541). Conclusion The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture. Key Points:  Citation Format

scholarly journals Alternative option for osteogenesis imperfecta and trigeminal neuralgia

2017 ◽  
Vol 63 (4) ◽  
pp. 307-310 ◽  
Author(s):  
Leonardo Gilmone Ruschel ◽  
Guilherme José Agnoletto ◽  
Sonival Cândido Hunhevicz ◽  
Daniel Benzecry de Almeida ◽  
Walter Oleschko Arruda
Keyword(s):  
Trigeminal Neuralgia ◽  
Osteogenesis Imperfecta ◽  
Skull Base ◽  
Cranial Nerves ◽  
Percutaneous Treatment ◽  
Basilar Invagination ◽  
Gasserian Ganglion ◽  
Ct Guided ◽  
Alternative Option ◽  
Percutaneous Balloon

Summary Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year-old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.

Multimodality Imaging Guidance in Interventional Pain Management

2016 ◽  
Keyword(s):  
Computed Tomography ◽  
Pain Management ◽  
Soft Tissue ◽  
Radiation Exposure ◽  
Multimodality Imaging ◽  
Standard Of Care ◽  
Ultrasound Guided ◽  
Ct Guided ◽  
Imaging Guidance ◽  
Interventional Pain Management

Multimodality Imaging Guidance for Interventional Pain Management is a comprehensive resource covering fluoroscopy-guided procedures, ultrasound interventions, and computed tomography (CT)-guided procedures used in interventional pain management. Fluoroscopy-guided procedures have been the standard of care for many years and are widely available and affordable. Due to the lack of radiation exposure and the ability to see various soft tissue structures, ultrasound-guided interventions are more precise and safer. The benefits, disadvantages, and basic techniques of CT-guided procedures, primarily performed by radiologists, are also included in the volume. By covering all imaging modalities, Multimodality Imaging Guidance for Interventional Pain Management allows for an efficient comparison of the capabilities of each modality.

Percutaneous electrocoagulation of the trigeminal nerve using CT guidance

1988 ◽  
Vol 68 (6) ◽  
pp. 972-973 ◽  
Author(s):  
George Krol ◽  
Ehud Arbit
Keyword(s):  
Skull Base ◽  
Computerized Tomography ◽  
Trigeminal Nerve ◽  
Ct Guidance ◽  
Gasserian Ganglion ◽  
Foramen Ovale ◽  
Content Type ◽  
Scout View ◽  
Fine Print

✓ Computerized tomography guidance can be used during placement of an electrode for the ablation of the trigeminal nerve or gasserian ganglion. A combination of a scout view and axial images through the skull base provides adequate visualization of the needle and foramen ovale. This method is recommended in patients who cannot be properly positioned for fluoroscopy or when there is poor visualization of the foramen on conventional radiographs.

P6190Dynamic stress CTP with a whole-heart coverage scanner in addition to cCTA and FFRCT

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Baggiano ◽  
M Guglielmo ◽  
G Muscogiuri ◽  
L Fusini ◽  
A Del Torto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Radiation Exposure ◽  
Dynamic Stress ◽  
Functional Evaluation ◽  
Ct Scanner ◽  
Fractional Flow ◽  
Computed Tomography Perfusion ◽  
Flow Reserve ◽  
Whole Heart

Abstract Background Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experience used technology that was associated with high radiation exposure. Purpose The aim of the study is to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus FFR computed tomography derived (FFRCT) by using a whole-heart coverage CT scanner as compared to invasive coronary angiography (ICA) plus clinically indicate invasive fractional flow reserve (FFR). Methods Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner. FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant CAD in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. Results The prevalence of obstructive CAD and functionally significant CAD were 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT and cCTA+CTP, were 83% and 66%, 86% and 75%, 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared to cCTA alone (0.826, p<0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919, p<0.05) as compared to all other strategies. The mean ED for cCTA and stress CTP was 2.8±1.2 and 5.3±0.7 mSv, respectively. Conclusions The addition of dynamic stress CTP on top of cCTA and FFRCT provides additional diagnostic accuracy with acceptable radiation exposure.

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