Georgiopoulos Miltiadis, Ellul John, Chroni Elisabeth, Constantoyannis Constantine
Functional Neurosurgery Unit, Department of Neurosurgery, Faculty of Medicine, University of Patras, 26500 Patras, Greece.
Department of Neurology, Faculty of Medicine, University of Patras, 26500 Patras, Greece.
ISRN Neurol. 2014 Mar 9;2014:630418. doi: 10.1155/2014/630418. eCollection 2014.
Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012.
preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient's forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.
目的。经皮球囊压迫术（PBC）是治疗药物难治性三叉神经痛的一种有效且安全的方法；然而，仅使用荧光镜检查未能成功插管卵圆孔（FO）在某些情况下是一个重大问题。在本文中，我们建议在因先前荧光镜检查下插管FO技术失败而再次手术的病例中使用术中导航。方法。自2003年以来，共有174例患者接受了PBC治疗三叉神经痛。其中9例未成功穿透FO。2012年3月至2012年9月，对其中5例患者使用导航进行了PBC再次手术。
术前，进行头部计算机断层扫描（CT）并将获取的图像导入导航系统。术中，将一个小参考框架牢固地绑在患者前额，对CT图像进行配准，并在导航系统引导下进行插管。结果。所有患者手术均成功完成。此外，所有患者术后立即报告疼痛完全缓解，总体未记录到并发症。结论。我们建议在PBC技术失败的病例中使用神经导航。该技术具有显著优势，有助于成功插管FO，且似乎更高效、更安全。
