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| 22KS-007 |
Pre-procedure Virtual Simulation for Gasserian Ganglion Block : A Case Report
Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital
Introduction
Most pain management techniques for challenging procedures are still performed under the guidance of the C-arm although it is sometimes difficult for even experienced clinicians to understand the 3D anatomy with a 2D X-ray image. When a challenging procedure is to be performed, a pre-procedural virtual simulation made by a doctor, which is tailored for each patient, can be performed to enhance anatomical understanding and successfully perform the procedure without trial and error.
We developed a computer program to simulate the actual environment of the procedure. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, we searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified.
In this case report, we presented a case of successful Gasserian ganglion block through pre-procedural virtual simulation.
Case
A 69-year-old woman visited our hospital complaining of pain in the left cheek that had begun suddenly and felt like an electric shock and stab (as described by the patient). A pain a score of 8 the numerical rating scale. The pain lasted for 1 eating. We established a diagnosis of trigeminal neuralgia and planned a Gasserian ganglion block using an anterior approach to relieve the symptoms of the patient. However, this procedure also makes it challenging to identify the target point (i.e., the foramen ovale) under fluoroscopic guidance, and there is a risk of injury to the surrounding structures. We attempted a pre-procedural virtual simulation to understand the complex structures of the skull. The skull bone was embodied in a virtual simulation using head CT. After accurately positioning the needle in the foramen ovale, we adjusted the virtual C-arm to view the needles as a point and saved the lateral view (Figures 1).
Subsequently, when the patient visited the hospital, we approached the foramen ovale as implemented in the virtual simulation, and the procedure was performed easily without complications (Figures 2).
Conclusion
We created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.
Most pain management techniques for challenging procedures are still performed under the guidance of the C-arm although it is sometimes difficult for even experienced clinicians to understand the 3D anatomy with a 2D X-ray image. When a challenging procedure is to be performed, a pre-procedural virtual simulation made by a doctor, which is tailored for each patient, can be performed to enhance anatomical understanding and successfully perform the procedure without trial and error.
We developed a computer program to simulate the actual environment of the procedure. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, we searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified.
In this case report, we presented a case of successful Gasserian ganglion block through pre-procedural virtual simulation.
Case
A 69-year-old woman visited our hospital complaining of pain in the left cheek that had begun suddenly and felt like an electric shock and stab (as described by the patient). A pain a score of 8 the numerical rating scale. The pain lasted for 1 eating. We established a diagnosis of trigeminal neuralgia and planned a Gasserian ganglion block using an anterior approach to relieve the symptoms of the patient. However, this procedure also makes it challenging to identify the target point (i.e., the foramen ovale) under fluoroscopic guidance, and there is a risk of injury to the surrounding structures. We attempted a pre-procedural virtual simulation to understand the complex structures of the skull. The skull bone was embodied in a virtual simulation using head CT. After accurately positioning the needle in the foramen ovale, we adjusted the virtual C-arm to view the needles as a point and saved the lateral view (Figures 1).
Subsequently, when the patient visited the hospital, we approached the foramen ovale as implemented in the virtual simulation, and the procedure was performed easily without complications (Figures 2).
Conclusion
We created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.
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