Navigated minimally invasive puncture of the trigeminal cistern in horses-a cadaveric study in preparation for a controlled rhizotomy.
Authors: de Preux Mathieu, Precht Christina, Becker Richard, Stieglitz Lennart, Easley Jeremiah, Koch Christoph
Journal: Frontiers in veterinary science
Summary
Trigeminal-mediated headshaking in horses represents a challenging neuropathic condition analogous to trigeminal neuralgia in humans, for which glycerol rhizotomy—chemical ablation of pain-conducting fibres within the trigeminal ganglion—offers a potential therapeutic pathway already established in human neurosurgery. De Preux and colleagues evaluated two needle-access routes to the equine trigeminal cistern using image-guided navigation: a previously reported ventral approach and a novel transmandibular lateral technique, assessing surgical accuracy and the risk of inadvertent damage to adjacent neurovascular and bony structures using cadaveric specimens. The transmandibular lateral approach demonstrated improved precision in targeting the trigeminal cistern whilst reducing proximity to critical structures, suggesting enhanced safety margins compared with the ventral route. These findings carry significant implications for equine practitioners managing intractable headshaking cases, offering a more anatomically favourable technique that may improve treatment efficacy and reduce complications when glycerol rhizotomy becomes available as a clinical procedure. Whilst this remains cadaveric validation work, it represents essential groundwork for transitioning this human neurosurgical technique into controlled equine applications, potentially transforming outcomes for horses suffering from this debilitating condition.
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Practical Takeaways
- •Navigated glycerol rhizotomy offers a potential treatment option for horses with trigeminal-mediated headshaking, a previously difficult-to-manage neuropathic pain condition
- •The transmandibular lateral approach may provide an alternative access route to the trigeminal cistern with different anatomical risk profiles compared to the ventral approach
- •This cadaveric validation work supports progression toward clinical trials for a minimally invasive procedure that could improve outcomes for horses with headshaking
Key Findings
- •Two navigated approaches to the equine trigeminal cistern were compared: ventral and transmandibular lateral approaches for glycerol rhizotomy
- •Navigation system guidance was used to assess surgical accuracy and risk of iatrogenic collateral damage in cadaveric specimens
- •Study evaluated feasibility of minimally invasive puncture techniques as preparation for controlled rhizotomy in horses with trigeminal-mediated headshaking