Omneity® Pellets
All-In-One Vitamin & Mineral Pellet
Navigated minimally invasive puncture of the trigeminal cistern in horses-a cadaveric study in preparation for a controlled rhizotomy.
Abstract: Trigeminal-mediated headshaking is a neuropathic disorder in horses, characterized by signs of regional pain similar to trigeminal neuralgia in humans. The injection of glycerol into the trigeminal cistern to ablate pain-conducting nerve fibers within the trigeminal ganglion -known as glycerol rhizotomy- is a well-established treatment in human medicine. This study compares two approaches to the equine trigeminal cistern using a navigation system for guiding needle placement, a previously described ventral and a newly developed transmandibular lateral approach. The surgical accuracy and risk of iatrogenic collateral damage for the two approaches are assessed. Unassigned: Five equine cadaveric specimens were used in this study. Magnetic resonance imaging (MRI) of the target region was performed using a 3 T MRI, followed by cone beam computed tomography (CBCT). The two datasets were fused in a surgical navigation system. A trajectory for a ventral navigated approach (VNA) to the trigeminal cistern was planned on one side and for a transmandibular lateral navigated approach (TLNA) on the contralateral side, using the system's planning function. The trigeminal cistern was punctured after introducing the needle along the planned trajectory under real-time navigation guidance, and a toluidine blue solution was injected. A titanium rod was then inserted as a stylet to place a titanium seed within the trigeminal cistern. The rod was left in place to allow artifact-free postprocedural assessment of the surgical trajectory and to measure surgical accuracy aberration (SAA). Prior to dissection, an endoscopic examination was performed to identify any potential perforation of the guttural pouches. Unassigned: Successful puncture of the trigeminal cistern was achieved in 5/5 specimens via the TLNA, with a median SAA of 3.92 mm (range 3.42 mm - 4.55 mm) and in 3/5 specimens via the VNA, with a median SAA of 6.45 mm (range 2.89 mm - 10.85 mm). The VNA resulted in iatrogenic injury to the internal carotid artery in two cases, and the linguofacial artery in another case. Focal perforation of the mucosa of the guttural pouch was observed in one specimen injected via TLNA. Unassigned: The TLNA enables accurate and precise minimally invasive puncture of the equine trigeminal cistern in an experimental setting.
Copyright © 2025 de Preux, Precht, Becker, Stieglitz, Easley and Koch.
Publication Date: 2025-06-13 PubMed ID: 40586033PubMed Central: PMC12202215DOI: 10.3389/fvets.2025.1562404Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research aims to investigate two methods of accessing the equine trigeminal cistern, an area of a horse’s neural system that often triggers pain, using a navigation system to direct needle placement. This is performed in preparation for a procedure called ‘glycerol rhizotomy,’ a treatment for trigeminal-mediated headshaking, a pain disorder in horses.
Research Methodology
- The study used five equine cadaveric specimens.
- The researchers carried out Magnetic Resonance Imaging (MRI) using a 3 T MRI and cone beam computed tomography (CBCT) to capture detailed images of the target area.
- These images were combined in a surgical navigation system to help guide needle placement.
- The team planned a trajectory for the needle using the surgical navigation system for both a ventral navigated approach (VNA) and a transmandibular lateral navigated approach (TLNA).
- The trigeminal cistern was punctured along the planned trajectory while observing real-time navigation, followed by an injection of toluidine blue solution for visibility.
- A titanium rod was then inserted to place a titanium seed within the trigeminal cistern, and left in place for postprocedural assessment and to measure surgical accuracy.
- An endoscopic examination was performed before dissection to check for any potential guttural pouch perforation.
Results
- Puncturing the trigeminal cistern successfully was achieved in 5 out of 5 specimens using the TLNA approach, with a median surgical accuracy aberration (SAA) of around 3.92mm.
- Using the VNA approach, the cistern was successfully punctured in 3 out of 5 specimens, with a higher median SAA of 6.45mm.
- The VNA approach resulted in iatrogenic injury (damage caused by medical treatment) to the internal carotid artery in two cases, and to the linguofacial artery in one case.
- One specimen injected using the TLNA approach showed a focal perforation in the mucosa of the guttural pouch.
Conclusion
The research found that the TLNA approach provides a more accurate and precise means of minimally invasive puncture of the equine trigeminal cistern in an experimental setting, albeit with some risk of damage. The risk of injury was found to be significant with the VNA approach, suggesting that the TLNA might be a safer choice for potential future procedures.
Cite This Article
APA
de Preux M, Precht C, Becker R, Stieglitz L, Easley J, Koch C.
(2025).
Navigated minimally invasive puncture of the trigeminal cistern in horses-a cadaveric study in preparation for a controlled rhizotomy.
Front Vet Sci, 12, 1562404.
https://doi.org/10.3389/fvets.2025.1562404 Publication
Researcher Affiliations
- Division of Equine Surgery, Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Science, Vetsuisse-Faculty, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
- Division of Clinical Radiology, Department of Clinical Veterinary Science, Vetsuisse-Faculty, University of Bern, Bern, Switzerland.
- Division of Equine Surgery, Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Science, Vetsuisse-Faculty, University of Bern, Bern, Switzerland.
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Translational Medicine Institute, Colorado State University, Fort Collins, CO, United States.
- Division of Equine Surgery, Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Science, Vetsuisse-Faculty, University of Bern, Bern, Switzerland.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
This article includes 36 references
- Roberts V. Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies.. Vet Med (Auckl) (2019) 10:1–8.
- Aleman M, Williams D, Brosnan R, Nieto J, Pickles K, Berger J. Sensory nerve conduction and somatosensory evoked potentials of the trigeminal nerve in horses with idiopathic headshaking.. J Vet Intern Med (2013) 27:1571–80.
- Pickles K, Madigan J, Aleman M. Idiopathic headshaking: is it still idiopathic?. Vet J (2014) 201:21–30.
- Newton S, Knottenbelt D, Eldridge P. Headshaking in horses: possible aetiopathogenesis suggested by the results of diagnostic tests and several treatment regimes used in 20 cases.. Equine Vet J (2000) 32:208–16.
- Mair T. Assessment of bilateral infra-orbital nerve blockade and bilateral infra-orbital neurectomy in the investigation and treatment of idiopathic headshaking.. Equine Vet J (1999) 31:262–4.
- Roberts V, McKane S, Williams A, Knottenbelt D. Caudal compression of the infraorbital nerve: a novel surgical technique for treatment of idiopathic headshaking and assessment of its efficacy in 24 horses.. Equine Vet J (2009) 41:165–70.
- Roberts V, Perkins J, Skärlina E, Gorvy D, Tremaine W, Williams A. Caudal anaesthesia of the infraorbital nerve for diagnosis of idiopathic headshaking and caudal compression of the infraorbital nerve for its treatment, in 58 horses.. Equine Vet J (2013) 45:107–10.
- Bell C, Hnenny L, Torske K. Internal neurolysis of the maxillary branch of the trigeminal nerve for the treatment of equine trigeminal mediated headshaking syndrome.. Can Vet J (2018) 59:763.
- Bick SK, Eskandar EN. Surgical treatment of trigeminal neuralgia.. Neurosurg Clin (2017) 28:429–38.
- Janjua RM, Al-Mefty O, Densler DW, Shields CB. Dural relationships of Meckel cave and lateral wall of the cavernous sinus.. Neurosurg Focus (2008) 25:E2.
- Hartley F. Intracranial neurectomy of the second and third divisions of the fifth nerve.. New York J Med (1892) 55:317.
- Becker R, Haenssgen K, Precht C, Khoma O-Z, Hlushchuk R, Koch C. An anatomical study of the subarachnoid space surrounding the trigeminal ganglion in horses—in preparation for a controlled glycerol rhizotomy in equids.. Front Vet Sci (2024) 11:1424890.
- Winter JC, Haist V, Feige K. Examination on the effectiveness of a glycerol injection at the trigeminal nerve as a basis for the treatment of headshaking in the horse.. Pferdeheilkd Equine Med (2014) 30:252–62.
- Uhlendorf F, Müller J-M, Winter JC, Feige K. Therapie des idiopathischen Headshaking durch Injektionvon Glycerol in das Ganglion trigeminale bei einer 5-jährigen Warmblutstute.. Pferdeheilkunde (2011) 27:585–588.
- Kaplan M, Erol FS, Ozveren MF, Topsakal C, Sam B, Tekdemir I. Review of complications due to foramen ovale puncture.. J Clin Neurosci (2007) 14:563–8.
- Peris-Celda M, Graziano F, Russo V, Mericle RA, Ulm AJ. Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications.. J Neurosurg (2013) 119:1176–93.
- Wu FHW, Cheung CW, Leung YY. Neuronavigation-guided percutaneous Rhizotomies to trigeminal neuralgia: a systematic review.. Clin J Pain (2024) 40:253–66.
- Oertel MF, Sarnthein J, Regli L, Stieglitz LH. Peroral trigeminal rhizotomy using a novel 3-dimensional printed patient-specific guidance tool.. Oper Neurosurg (2021) 21:491–6.
- Tsai P-J, Lee M-H, Chen K-T, Huang W-C, Yang J-T, Lin MH-C. Foramen ovale cannulation guided by intraoperative computed tomography with magnetic resonance image fusion plays a role in improving the long-term outcome of percutaneous radiofrequency trigeminal rhizotomy.. Acta Neurochir (2019) 161:1427–34.
- Pérez-Bovet J, Caro Cardera JL, Rimbau Muñoz J. Frameless navigation-guided percutaneous rhizotomy of the trigeminal nerve: an appraisal of the literature.. Neurosurg Rev (2022) 45:405–10.
- de Preux M, Klopfenstein Bregger MD, Brünisholz HP, Van der Vekens E, Schweizer-Gorgas D, Koch C. Clinical use of computer-assisted orthopedic surgery in horses.. Vet Surg (2020) 49:1075–87.
- de Preux M, Van der Vekens E, Racine J, Sangiorgio D, Klopfenstein Bregger MD, Brünisholz HP. Accessory carpal bone fracture repair by means of computer-assisted orthopaedic surgery in a warmblood stallion.. Equine Vet Educ (2022) 34:e478–84.
- Greim E, de Preux M, Koch C, Petruccione I, Klopfenstein Bregger MD, Van der Vekens E. Computer-assisted removal of an ectopic tooth from the mandibular fossa through a mandibular condylectomy approach in a Comptois gelding.. Equine Vet Educ (2023) 35:e364–71.
- de Preux M, Precht C, Guevar J, Graubner C, Thenhaus-Schnabel S, Buser L. A transmandibular lateral transsphenoidal navigated surgical approach to access a pituitary macroadenoma in a warmblood mare.. Vet Q (2024) 44:1–10.
- de Preux M, Precht C, Travaglini AT, Propadalo LM, Farra D, Vidondo B. Influence of the vertek aiming device on the surgical accuracy of computer-assisted drilling of the equine distal sesamoid bone—an experimental cadaveric study.. Vet Surg (2024) 54:118–28.
- Wickham H. ggplot2: Elegant graphics for data analysis.. New York: Springer-Verlag; (2016).
- Wickham H, Vaughan D, Girlich M. tidyr: Tidy Messy Data.. R package version 1.3.1. (2024).
- Xia Y, Yu G, Min F, Xiang H, Huang J, Leng J. The focus and new progress of percutaneous balloon compression for the treatment of trigeminal neuralgia.. J Pain Res (2022) 15:3059–68.
- Tauber M, Van Loveren HR, Jallo G, Romano A, Keller JT. The enigmatic foramen lacerum.. Neurosurgery (1999) 44:386–91.
- Khairuddin NH, Sullivan M, Pollock PJ. Angiographic variation of the internal carotid artery and its branches in horses.. Vet Surg (2015) 44:784–9.
- Texakalidis P, Xenos D, Tora MS, Wetzel JS, Boulis NM. Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: a systematic review and meta-analysis.. Clin Neurol Neurosurg (2019) 182:112–22.
- Chang KW, Jung HH, Chang JW. Percutaneous procedures for trigeminal neuralgia.. J Korean Neurosurg Soc (2022) 65:622–32.
- Fairburn AJ, Meehan LJ, Roberts VL. Computed tomographic findings in 101 horses presented for the investigation of headshaking.. Equine Vet Educ (2023) 35:e339–45.
- Kloock T, Hellige M, Kloock A, Feige K, Niebuhr T. Impact of different diagnostic procedures on diagnosis, therapy, and outcome in horses with headshaking: recommendations for fast-track advanced diagnostic and therapeutic protocols.. Animals (2022) 12:3125.
- Manso-Díaz G, Garcia-Real M, Casteleyn C, San-Roman F, Taeymans O. Time-of-flight magnetic resonance angiography (TOF-MRA) of the normal equine head.. Equine Vet J (2013) 45:187–92.
- Piper KF, Flores-Milan G, Cruz AM, Kumar JI, van Loveren H. A nod for Meckel: a novel surgical position utilizing Meckel's cave anatomy for percutaneous glycerol Rhizotomy in trigeminal neuralgia.. J Neurol Surg B Skull Base (2024) 85:156–60.
Citations
This article has been cited 1 times.- Klopfenstein Bregger MD, de Preux M, Brünisholz HP, Van der Vekens E, Schweizer D, Koch C. Cheek tooth repulsion aided by computer-assisted surgery in 16 equids. Front Vet Sci 2025;12:1571539.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
