Robot-assisted trigeminal nerve rhizotomy with radiofrequency ablation using Globus ExcelsiusGPS: illustrative case

Abstract

Background: Trigeminal neuralgia (TN) is a disorder of chronic facial pain and can be treated by radiofrequency ablation (RFA) rhizotomy of the trigeminal nerve. The use of robotic systems like the Globus ExcelsiusGPS may enhance precision and safety in intracranial procedures.

Observations: A 58-year-old male with a history of TN unresponsive to multiple treatments, including microvascular decompression (MVD) and Gamma Knife radiosurgery, underwent robot-assisted RFA rhizotomy. The Globus ExcelsiusGPS robot was used to guide a needle precisely to the gasserian ganglion through the foramen ovale. The needle's trajectory was confirmed via intraoperative CT, and RFA was performed at 70°C for 90 seconds. The procedure was well tolerated with no complications. The patient reported immediate improvement in left-sided facial pain postoperatively and was discharged the following day. At the 2-week follow-up, the patient showed resolution of preoperative symptoms. The successful implementation of robot-assisted RFA rhizotomy using the Globus ExcelsiusGPS robot for TN resulted in significant pain relief and minimal complications.

Lessons: This report demonstrates the potential of robot-assisted RFA in improving surgical precision, control, and patient outcomes in TN treatment. Further investigation into the long-term efficacy and safety of this innovative approach is warranted to fully understand its benefits and accuracy. https://thejns.org/doi/10.3171/CASE2510.

Keywords: case report; radiofrequency ablation; robotic neurosurgery; trigeminal neuralgia; trigeminal rhizotomy.

FIG. 1.

Sagittal (left) and axial (right) intraoperative CT scans showing placement of the needle through the end effector of the ExelsiusGPS robot into the left-sided foramen ovale.

FIG. 2.

Three-dimensional reconstruction of an intraoperative CT scan demonstrating entry point of the needle through the robot’s end effector, toward the skull base and its intended target in the foramen ovale.

FIG. 3.

Postoperative axial CISS sequence MR image with gadolinium contrast, showing abnormal hyperintensity with contrast enhancement in the left gasserion ganglion (oval).