Case series of CT-fusion and real-time US-guidance in percutaneous RF thermocoagulation for trigeminal rhizotomy

This case series evaluates the feasibility, safety, and efficacy of real-time computed tomography fusion with ultrasound guidance (CTF-USG) in percutaneous radiofrequency thermocoagulation (RFT) for trigeminal rhizotomy. Traditional imaging modalities such as CT and fluoroscopy lack real-time visualization, increasing the risk of vascular injury and reducing procedural precision. The CTF-USG technique integrates CT imaging with real-time ultrasound via electromagnetic tracking, enabling accurate needle navigation and anatomical confirmation. Six patients with refractory trigeminal neuralgia affecting the V2 or V3 divisions underwent RFT guided by CTF-USG. All procedures achieved first-attempt needle placement success with no immediate complications. Postoperative assessments demonstrated significant reductions in pain scores at one and three months. The real-time imaging capability facilitated avoidance of critical structures, enhanced procedural safety. In conclusion, CTF-USG offers real-time imaging superior to C-arm fluoroscopy or standard CT, reducing complications and improving procedural accuracy. Primary technique efficacy was 100%. These advantages support its adoption in treating refractory trigeminal neuralgia.