Open AccessA Cadaver Study Confirming the Location of Dye after Trigeminal Ganglion Rhizotomy
Author(s) -
SouHyun Lee,
JiHee Hong,
Hye-Ra Jung
Publication year - 2021
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2021/24/e341
Subject(s) - rhizotomy , medicine , anatomy , plexus , trigeminal neuralgia , cadaver , cadaveric spasm , percutaneous , trigeminal ganglion , trigeminal nerve , radiofrequency thermocoagulation , ganglion , surgery , biology , dorsum , sensory system , neuroscience
Background: Radiofrequency thermal rhizotomy demonstrates an excellent treatment outcomewith a high success rate among patients of intractable trigeminal neuralgia. The triangular plexuswhich is an immediate retrogasserian portion of the trigeminal root is suggested as the best place oflesioning during radiofrequency thermal rhizotomy. However, the anatomy of the triangular plexushas been relatively unrecognized, while the anatomical study related to therapeutic procedure isscarce.Objective: The purpose of this study is to confirm with gross and microscopic finding of thetrigeminal system whether, if an electrode tip is placed on the petroclival junction in lateral cranialview, it actually arrives at the triangular plexus or not. In relation to therapeutic procedure, weexamined the triangular plexus with morphological and histological methods.Study Design: Human cadaveric study.Setting: An anatomical laboratory in South Korea.Methods: Percutaneous procedure of radiofrequency thermal rhizotomy under C-arm guidancewas performed in 8 cadavers. Final target of the electrode tip was the petroclival junction undertrue lateral cranial view. The location of the electrode tip was determined under observation of thepresence of an injected dye. Triangular plexus size was measured grossly and microscopically. Grossand microscopic evaluation of the triangular plexus was performed.Results: Among 15 trigeminal systems, 8 showed dye appearance in the triangular plexus, while6 showed it in the trigeminal ganglion. Overall, 53% of radiofrequency thermal rhizotomy couldreach the triangular plexus when an electrode tip was placed on the petroclival junction. The grosslymeasured average triangular plexus vertical and transverse diameters were 0.8 cm and 1.3 cm,respectively.Limitation: Only radiologic landmark was used to confirm the location of the electrode tip.However, further study confirming the location of the electrode tip under the guidance of electricalstimulation is needed.Conclusion: When an electrode tip was placed on the petroclival junction, 53% of radiofrequencythermal rhizotomy could reach the triangular plexus.Key words: Petroclival junction, trigeminal neuralgia, triangular plexus, radiofrequency thermalrhizotomy