Nevralgia de trigemen. Abordare modernă a tehnicei percutane clasice

Abstract

Scopul acestei lucrări este de a prezenta termocoagularea percutana cu radiofrecvenţa transforamen oval ghidată de neuronavigaţie în tratamentul nevralgiei de trigemen esenţiale. Metode. Utilizarea neuronavigatiei în vederea localizării cu precizie maximă a foramenului oval a fost utilizată la 4 pacienţi cu nevralgie de trigemen în perioada 01.12.2006 – 30.04.2007. Toţi patru pacienţi au dezvoltat farmacorezistență la tratamentul medicamentos al nevralgiei de trigemen. Vârsta pacienţilor a fost între 62 și 78 ani. Rezultate. Neuronavigatia oferă o precizie crescută în timpul localizării foramenului oval în vederea termocoagulării cu radiofrecvența a ganglionului Gasser, ducând la sporirea confortului neurochirurgului în momentul atingerii țintei si reducerea riscului de posibile complicaţii ale acestei proceduri. Concluzii. Termocoagularea cu radiofrecvenţă percutană transforamen oval ghidată de neuronavigatie este o metodă sigură și promiţătoare pentru tratamentul nevralgiei de trigemen primare rezistent la medicamente, oferind controlul bun al durerii și reducerea riscului complicaţiilor existente în timpul «vânătorii» foramenului oval în metoda clasică.

The objective of this work is to present preliminary results of neuronavigation-guided percutaneous radiofrequency thermocoagulation în the treatment of trigeminal neuralgia. Methods. Percutaneous radiofrequency thermocoagulation guided by neuronavigation was used în four patients with trigeminal neuralgia admitted to our hospital between 01.12.2006 and 30.04.2007. All patients developed pharmacoresistence to drugs used în the treatment of trigeminal or have had adverse effects due to drug toxicity. The age of the patients was between 62 and 78 years. Results. All the patients had an immediate pain relief after the percutaneous thermocoagulation guided by neuronavigation. în one case where, trigeminal neuralgia was secondary to petroclival meningioma the pain has recurrence shortly after the operation. Neuronavigation is a useful tool that gives to the neurosurgeon the comfort of direct visualization of instrument position în any time of the operation. It helps preoperative planning of the optimal trajectory for needle insertion and together with intraoperative stimulation provides an increased precision of foramen ovale targeting, reducing the risk of complication associated with this procedure. Conclusion. Percutaneous thermocoagulation guided by neuronavigationin the treatment of essential neuralgia is a safe and promising procedure. It gives a good pain control and reduce the risk of postoperative complications caused by hunting of foramen ovale.

The objective of this work is to present preliminary results of neuronavigation-guided percutaneous radiofrequency thermocoagulation în the treatment of trigeminal neuralgia. Methods. Percutaneous radiofrequency thermocoagulation guided by neuronavigation was used în four patients with trigeminal neuralgia admitted to our hospital between 01.12.2006 and 30.04.2007. All patients developed pharmacoresistence to drugs used în the treatment of trigeminal or have had adverse effects due to drug toxicity. The age of the patients was between 62 and 78 years. Results. All the patients had an immediate pain relief after the percutaneous thermocoagulation guided by neuronavigation. în one case where, trigeminal neuralgia was secondary to petroclival meningioma the pain has recurrence shortly after the operation. Neuronavigation is a useful tool that gives to the neurosurgeon the comfort of direct visualization of instrument position în any time of the operation. It helps preoperative planning of the optimal trajectory for needle insertion and together with intraoperative stimulation provides an increased precision of foramen ovale targeting, reducing the risk of complication associated with this procedure. Conclusion. Percutaneous thermocoagulation guided by neuronavigationin the treatment of essential neuralgia is a safe and promising procedure. It gives a good pain control and reduce the risk of postoperative complications caused by hunting of foramen ovale.