Tag: Trigeminal ganglion

Posted on

Feasibility of Robotic Transorbital Surgery

Operative Neurosurgery 28:506–510, 2025

This study explores the feasibility of robotic-assisted lateral transorbital surgery for accessing Meckel cave. Challenges include tool size and limited entry space, though internal surgical space is adequate. Future advancements in smaller, haptic-enabled tools could enhance the practicality of this approach.

• The study explores the feasibility of robotic-assisted lateral transorbital approach (LTOA) using the DaVinci Xi model for neurosurgery.

• Six cadaver heads were used for dissection to evaluate tool insertion and movement.

• The current robotic tools are too large for effective LTOA, limiting the insertion to one tool and a camera.

• Removing the lateral orbital rim (LOR) provides more space but still limits tool usage due to size constraints.

• There is potential for LTOA with smaller, more precise tools in the future, offering a wide surgical field around Meckel cave.

• The study highlights the need for development of narrower robotic instruments and haptic feedback systems for better surgical outcomes.

• Multiportal techniques, like adding a transnasal portal, could enhance tool use, but haptic feedback remains a critical need.

Posted on

The pathophysiology of trigeminal neuralgia: a molecular review

J Neurosurg 139:1471–1479, 2023

The goal of this study was to provide a comprehensive overview of the current understanding of molecular and genetic mechanisms underlying the pathophysiology of trigeminal neuralgia (TN).

METHODS The authors searched PubMed systematically for primary research literature investigating specific molecular mechanisms from samples derived from patients with TN. The genes/molecules of interest from the selected literature were then cross-referenced with corresponding studies in animal models of TN.

RESULTS From approximately 345 articles, a total of 12 articles were selected and included in the review, focusing on ionotropic channel expressivity and mutations, reactive oxygen species expressivity, inflammatory marker expressivity, and microRNA expressivity. Of the 12 included articles, only 4 had studies completed in other animal models regarding the corresponding TN mechanism found in humans.

CONCLUSIONS The current literature does not suggest a conclusive disease mechanism for TN in humans. In addition to neurovascular conflict/compression of the trigeminal nerve, recent studies have indicated that TN may be linked to inflammatory and reactive oxygen species signaling as well. Recent genetic studies in patients with TN have yet to be investigated further in animal models.

Posted on

Morphology of the trigeminal ganglion: anatomical structures related to trigeminal radiofrequency rhizotomy

Acta Neurochirurgica (2022) 164:1551–1566

Trigeminal neuralgia is the most common example of craniofacial neuralgia. Its etiology is unknown and is characterized by severe episodes of paroxysmal pain. The trigeminal ganglion and its adjacent anatomical structures have a complex anatomy. The foramen ovale is of great importance during surgical procedures such as percutaneous trigeminal rhizotomy for trigeminal neuralgia.

Objective We aimed to identify the anatomical structures associated with the trigeminal ganglion and radiofrequency rhizotomy on cadavers and investigate their relationship with the electrodes used during rhizotomy to determine the contribution of the electrode diameter and length to the effectiveness of the lesion formation on the ganglion.

Methods Five fresh-frozen cadaver heads injected with red silicone/latex were used. A percutaneous puncture was made by inserting of a cannula through the foramen ovale to create a pathway for electrodes. The relationships between the electrodes, Meckel’s cave, trigeminal ganglion, and neurovascular structures were observed and morphometric measurements were obtained using a digital caliper.

Results Trigeminal ganglion, therefore the electrode in its final position, shows proximity with important anatomical structures. The electrode was inserted posteriorly into the foramen ovale in all of the specimens and was located on the retrogasserian fibers. This study revealed that the electrodes targeting the ganglion and passing through the foramen ovale may cause a radiofrequency lesion due to the contact effect of the dura itself pressing on the electrode. Pushing the cannula beyond the petroclival angle may result in puncturing of the dura propria and moving further away from the target area.

Conclusion The success of radiofrequency rhizotomy is directly related to the area affected by the lesion. Understanding the mechanism of action underlying this procedure will ensure the effectiveness, success, and sustainability of the treatment.

Posted on

How I do it: epidural anterior petrosectomy

Acta Neurochir (2011) 153:1161–1167. DOI 10.1007/s00701-011-1010-9

Among the potential approaches to access the petroclival area, epidural anterior petrosectomy (EAP) appears to be the most direct and conservative transpetrous route.

In this article, we aim to detail the relevant surgical steps necessary to perform EAP in a reproducible and safe manner.

Method The temporo-pterional bone flap is tailored to access the floor of the middle fossa and expose the foramen ovale and foramen spinosum. Elevation of the dura covering the upper surface of the petrous apex is conducted medially toward the level of the petrous ridge. Identification of the landmarks of the rhomboid fossa delineates the limits of the drilling zone (necessary for removal of the petrous apex)—beneath Meckel’s cave and just anterior to the anterior margin of the internal auditory meatus. The tentorium is divided at its free edge and is followed by opening of the posterior fossa dura.

Conclusion Epidural anterior petrosectomy is a conservative trans-petrous approach that offers an excellent direct surgical corridor for exposure of disease processes involving Meckel’s cave, the petroclival area and the ventrolateral pons

Proudly powered by WordPress