YAHYA EFE GÜNER, NECATİ SALMAN, ALİ SAVAŞ
Ankara Üniversitesi Tıp Fakültesi Mecmuası - 2023;76(4):361-368
Objectives: Percutaneous trigeminal radiofrequency rhizotomy (RFTC) is a safe and effective intervention for trigeminal neuralgia treatment. Hartel’s approach enables the surgeon to perform percutaneous foramen ovale interventions by using anatomical landmarks. We aimed to analyze the study results to verify the electrode angles and distances between the indicated anatomical landmark points. Materials and Methods: Between 2019 and 2022, 119 out of 121 patients evaluated who underwent RFTC at the neurosurgery department. We retrospectively analyzed the electrode angles and distances radiologically and postoperative pain relief. The RFTC in our study included four parameters: the distance between petrous apex (PA) and the needle tip reaching the Gasserian ganglion in the sagittal plane, the distance between PA and the dorsum sellae in the sagittal plane,the ratio of the first parameter to the second parameter, and last measurement was the angle between PA and the dorsum sella line and the line depicting the needle pathway. Results: There was a statistically significant difference in the PA-dorsum sellae distances between the successful and unsuccessful procedure groups (p<0.05). There was no statistically significant difference in the other three parameters between the two groups. The ratio of the two procedural distances was investigated to define the relation between the parameters and the success of the procedure. Receiver operating characteristic analysis was performed between PA-needle tip distance and PA-dorsum sellae distance Youden analysis of the area under the curve parameters had a cut-off value of <0.20. Conclusion: The success of the RFTC procedure is inversely proportional with the ratio of the PA-needle tip distance to the PA-dorsum sella distance (0.20 coefficient). This ratio is an easy-to-define, reliable, and simple parameter to predict success of the intervention. Since the number of studies on the RFTC method and its radiological interpretation is limited, more cadaver and clinical studies should be performed to avoid damaging neighboring structures, increase the success rate, and determine safe penetration points and angles.
