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
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Summary
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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.
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