Microendoscopic stereotactic-guided percutaneous radiofrequency trigeminal nucleotractotomy

Author(s)

Teixeira, Manoel Jacobsen ^[1] ; de Almeida, Fabricio Freitas ^[1] ; Almeida de Oliveira, Ywzhe Sifuentes ^[1] ; Fonoff, Erich Talamoni ^[1]

Affiliation

^[1] Univ Sao Paulo, Sch Med, Dept Neurol, Div Funct Neurosurg, Sao Paulo - Brazil

• Document type: Journal article
• Source: JOURNAL OF NEUROSURGERY; v. 116, n. 2, p. 331-335, FEB 2012.
• Web of Science Citations: 2

Abstract

Object. Over the past few decades, various authors have performed open or stereotactic trigeminal nucleotractotomy for the treatment of neuropathic facial pain resistant to medical treatment. Stereotactic procedures can be performed percutaneously under local anesthesia, allowing intraoperative neurological examination as a method for target refinement. However, blind percutaneous procedures in the region of the atlantooccipital transition carry a considerably high risk of vascular injuries that may bring prohibitive neurological deficit or even death. To avoid such complications, the authors present the first clinical use of microendoscopy to assist percutaneous radiofrequency trigeminal nucleotractotomy. The aim of this article is to demonstrate intradural microendoscopic visualization of the medulla oblongata through an atlantooccipital percutaneous approach. Methods. The authors present a case of severe postherpetic facial neuralgia in a patient who underwent the procedure and had satisfactory results. Stereotactic computational image planning for targeting the spinal trigeminal tract and nucleus in the posterolateral medulla was performed, allowing for an accurate percutaneous approach. immediately before radiofrequency electrode insertion, a tine endoscope was introduced to visualize the structures in the cisterna magna. Results. Microendoscopic visualization offered clear identification of the pial surface of the medulla oblongata and its blood vessels, the arachnoid membrane, cranial nerve rootlets and their entry zone, and larger vessels such as the vertebral arteries and the branches of the posterior inferior cerebellar artery. Conclusions. The initial application of this technique suggests that percutaneous microendoscopy may be useful for particular manipulation of the medulla oblongata, increasing the safety of the procedure and likely improving its effectiveness. (DOI: 10.3171/2011.8.JNS11618) (AU)

• FAPESP's process: 11/08529-5 - Double-blind controlled study on the effect of ozone applied for spinal endoscopy in the treatment of post-laminectomy pain syndrome: differential analysis in neuropathic and non-neuropathic pain and its correlation with the level of epidural cytokines
• Grantee: Erich Talamoni Fonoff
• Support Opportunities: Regular Research Grants