Application Of The Radiofrequency Thermocoagulation Of Gasserian Ganglion By Percutaneous Foramen Ovale Puncture From The Gonial Angle

ObjectiveTrigeminal neuralgia (TN) is one of the most common causes of persistent severe facial pain, especially in the elderly.Oral carbamazepine can temporary ameliorate the pain. TN is thought to be due to microvascular compression and demyelination of the trigeminal nerve at the root entry zone (REZ). Micro vascular decompression (MVD) is the surgical procedure of choice, which has an established safety and efficacy record. However, for some patients with poor cardiopulmonary function, or have other comorbidities, craniotomy may pose a substantial risk. When outcomes following microvascular decompression fail to achieve substantial pain relief, repeat craniotomy has a poor success rate.For such patients, percutaneous radiofrequency ablation (RFA) of the Gasserian ganglia through the foramen ovale is a potential therapeutic option.TN RFA is commonly performed using the Hartel anterior approach, which involves a puncture through the foramen ovale combined with electrophysiologic testing to find the target.Upon localizing the target, RFA is performed. The rate of recurrence and complications is substantial using this approach.Failure rates are as high as4%, and inadvertent puncture of the foramen lacerum and carotid artery, inferior orbital fissure, and jugular foramen have been reported.To minimize the risks associated with conventional cannulation techniques based upon anterior cutaneous landmarks, we adopted a novel technique of percutaneous mandibular cannulation of the foramen ovale for RFT of the Gasserian ganglion.This study was to evaluate the efficacy and safety of the treatment of primary trigeminal neuralgia using percutaneous radio-requency thermocoagulation of the Gasserian ganglion by percutaneous foramen ovale puncture from the gonial angle.Methods60cases of primary trigeminal neuralgia were randomly divided into Hartel group (group H) and gonial angle group(group G) with30cases respectively.Radio-requency thermocoagulation of the Gasserian ganglion was performed after neuronavigational puncture in the two groups seperately.The puncturing success rate and the complications rate between two groups were recorded.The VAS was scored respectively by1day,7days,1month,6months,12months,24months and36months post-treatment,the outcome responses of pain relief were evaluated using visual analog scale (VAS) and the Barrow Neurological Institute (BNI) scoring system.ResultsThe success rate of puncture and complications in puncturing showed no statistical significance (P>0.05),but the complication rate of Radio-requency in group H was higher then group G(P<0.05),and the treatment effect of group G is better then group H at12,24months and36months(P<0.05).Conclusion:The radio-requency thermocoagulation of the Gasserian ganglion by percutaneous foramen ovale puncture from the gonial angle owe more advantages including a lower complications rates,a high selectivity of target,lower recurrence rate, and the puncture path is more reasonable.