Tag: Gasserian ganglion

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Designing and clinical application of a 3D-printed personalized model of a radiofrequency needle guide with a maxillary fixator for puncture of the gasserian ganglion for trigeminal neuralgia treatment

J Neurosurg 142:1256–1262, 2025

The study presents a 3D-printed personalized model (3D PPM) for radiofrequency needle guidance in trigeminal neuralgia treatment, reducing radiation exposure and pain during procedures. It showed effectiveness in controlled needle insertion and minimized postoperative complications compared to traditional methods.

• A 3D-printed personalized model (3D PPM) of a radiofrequency needle guide with a maxillary fixator was designed for gasserian ganglion puncture in trigeminal neuralgia treatment.

• 3D PPM reduces radiation exposure and pain during needle insertion, and minimizes postoperative complications.

• The study found that the use of 3D PPM significantly decreased radiation time and dose area product compared to traditional methods.

• Pain severity during the procedure was less in patients using 3D PPM, with more reporting mild pain compared to those not using it.

• Cheek swelling was less frequent in the group using 3D PPM, though not statistically significant due to small sample size.

• The 3D PPM enhances the accuracy of needle insertion and reduces radiation exposure, making it beneficial for less experienced neurosurgeons.

• Limitations include the unsuitability for patients with metal dental implants or missing teeth due to fixation issues.

• Despite limitations, the study shows promising results for 3D PPM in radiofrequency therapy of the gasserian ganglion, suggesting further research is needed.

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Endoscopic endonasal approach to primitive Meckel’s cave tumors

Acta Neurochirurgica (2018) 160:2349–2361

Recently, an alternative endoscopic endonasal approach to Meckel’s cave (MC) tumors has been proposed. To date, few studies have evaluated the results of this route. The aim of our study was to evaluate long-term surgical and clinical outcome associated with this technique in a cohort of patients with intrinsic MC tumors.

Methods All patients with MC tumors treated at out institution by endoscopic endonasal approach (EEA) between 2002 and 2016 were included. Patients underwent brain MRI, CT-angiography, and neurological evaluation before surgery. Complications were considered based on the surgical records. All examinations were repeated after 3 and 12 months, then annually. The median follow-up was of 44.1 months (range 16–210).

Results The series included 8 patients (4 F): 5 neuromas, 1 meningioma, 1 chondrosarcoma, and 1 epidermoid cyst. The median age at treatment was 54.5 years (range 21–70). Three tumors presented with a posterior fossa extension. Radical removal of the MC portion of the tumor was achieved in 7 out of 8 cases. Two patients developed a permanent and transitory deficit of the sixth cranial nerve, respectively. No tumor recurrence was observed at follow-up.

Conclusion In this preliminary series, the EEA appeared an effective and safe approach to MC tumors. The technique could be advantageous to treat tumors located in the antero-medial aspects of MC displacing the trigeminal structures posteriorly and laterally. A favorable index of an adequate working space for this approach is represented by the ICA medialization, while tumor extension to the posterior fossa represents the main limitation to radical removal of this route.

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Endoscope-Assisted Retrosigmoid Intradural Suprameatal Approach for Surgical Treatment of Trigeminal Schwannomas

Endoscope-Assisted Retrosigmoid Intradural Suprameatal Approach

Operative Neurosurgery 10:565–575, 2014

Trigeminal schwannomas are the most common intracranial nonvestibular schwannomas, and the dumbbell-shaped subtype is the most challenging.

OBJECTIVE: To evaluate the efficiency and safety of the endoscope-assisted retrosigmoid intradural suprameatal approach (EA-RISA) for dumbbell trigeminal schwannomas and to compare EA-RISA with classic RISA.

METHODS: A retrospective study of all patients with trigeminal schwannomas was performed with a focus on dumbbell tumors. Tumors were classified according to a modified Samii classification. Extent of tumor removal, outcome, and morbidity rates in the 2 subgroups were compared.

RESULTS: Twenty patients were enrolled: 8 had dumbbell-shaped tumors (type C1), 8 had middle fossa tumors (A1-3), 3 had extracranial extension (D2), and 1 had posterior fossa tumor. Gross total resection was achieved in 15 and near-total resection in 5 patients. In 4 patients with dumbbell tumors, the classic RISA (Samii approach) was used; EA-RISA was used in the other 4 patients. The extent of petrous apex drilling was determined individually on the basis of the anatomic variability of suprameatal tubercle and degree of tumor-induced petrous apex erosion; in 2 patients, only minimal drilling was needed. The endoscope was applied after microsurgical tumor removal and in 3 of 4 patients revealed a significant unrecognized tumor remnant in the anterolateral and superolateral aspects of the Meckel cave. Thus, the EA-RISA technique allowed gross total resection of the tumor.

CONCLUSION: The EA-RISA enlarges the exposure obtained with the classic RISA. Its judicious use can help achieve safe and radical removal of dumbbell-shaped trigeminal schwannomas (C1 type).

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Trigeminal Schwannomas: Skull Base Approaches and Operative Results in 105 Patients

Neurosurgery 70[ONS Suppl 1]:ons132–ons144, 2012 DOI: 10.1227/NEU.0b013e31822efb21

Trigeminal schwannomas make up 0.8% to 8% of all intracranial schwannomas.

OBJECTIVE: To analyze our surgical experience with trigeminal schwannomas.

METHODS: We performed 107 operations on 105 patients harboring trigeminal schwannomas over the past 30 years. We classified the tumors as peripheral, ganglion cavernous, posterior fossa root, and dumbbell types according to the portion of the nerve that gave rise to the tumor.

RESULTS: Fourteen were peripheral-type tumors (13.1%), 39 (36.4%) were ganglion cavernous type, 22 (20.6%) were posterior fossa root type, and 32 (30.0%) were dumbbell type. Sixty-five tumors were solid, 35 were mixed, and only 7 were cystic. Among solid tumors, 14 were vascular, fibrous, and adherent to adjacent structures. Total or near-total removal was performed in 86 cases (81.9%), and subtotal removal was achieved in 18 (17.1%). The most common symptom was facial hypesthesia, occurring in 69 patients. This symptom improved in 11 patients, persisted in 50 patients, and worsened in 8 patients after surgery. New postoperative hypesthesia was observed in 8 patients. The second most common symptom was facial pain, observed in 24 patients. Facial pain subsided in 22 and persisted in 2 patients after surgery. Diplopia was observed in 21 patients. This symptom improved postoperatively in 14 patients, persisted in 6 patients, and worsened in 1 patient.

CONCLUSION: The present series demonstrates acceptable results using microsurgical treatment to remove trigeminal schwannomas. Pain and diplopia may be relieved after surgery; however, hypesthesia frequently remains or may be worsened by surgery.

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