Neuronavigation-Guided Percutaneous Rhizotomies to Trigeminal Neuralgia

Objective: Neuronavigation improves intraoperative visualisation to the cranial structures, which is valuable in percutaneous surgical treatments for trigeminal neuralgia (TN) patients who are refractory to pharmacotherapy or reluctant to receive open surgery. The objective of this review is to evaluate the available neuronavigation-guided percutaneous surgical treatment modalities with cannulation of foramen ovale to TN, and their relative benefits and limitations. Methods: This review was conducted based on the PRISMA statement. An initial search was performed on electronic databases, followed by manual and reference searches. Study and patient characteristics, rhizotomy procedure and neuronavigation details, and treatment outcomes (initial pain relief and pain recurrence within 2 years, success rate of forman ovale cannulation, and complications) were evaluated. Risk of bias was assessed with a quality assessment based on the ROBINS-I tools. Results: Ten studies (491 operations, 403 subjects) were analysed. Three percutaneous trigeminal rhizotomy modalities identified were radiofrequency thermocoagulation rhizotomy (RFTR), percutaneous balloon compression (PBC), glycerol rhizotomy. iCT/MRI RFTR had the highest initial pain relief rate of 97.0%. Success rate of FO cannulation ranged from 92.3% to 100% under neuronavigation. Facial hypoesthesia and masticatory muscle weakness were the most reported complications. Discussion: Neuronavigation-guided percutaneous trigeminal rhizotomies showed possible superior pain relief outcomes to that of conventional rhizotomies in TN, with the benefits of radiation reduction and lower complication development rates. Limitations of neuronavigation remain its high cost and limited availability. Higher-quality prospective studies and randomized clinical trials of neuronavigation-guided percutaneous trigeminal rhizotomy were lacking.