Percutaneous approach to the foramen ovale: an anatomical study of the extracranial trajectory with the incorrect trajectories to be avoided

AbstractBACKGROUNDThe cavernous sinus can be affected by pathologies with profound clinical implications. Therefore, obtaining an accurate diagnosis with minimal disruption of native tissue is needed. Percutaneous needle aspiration biopsy through the foramen ovale using the Härtel corridor is one option. The diagnostic yield is around 86%, typically failing in cases where the tissue is firm.OBJECTIVEThis work describes a new method of percutaneous biopsy to increase the diagnostic yield in cases where the tissue is firm and not deliverable into the biopsy needle via a suction device.METHODSUnder general anesthetic, a percutaneous approach through the foramen ovale was performed. A k-wire was then placed and the needle was removed. A 14-ga angiocatheter was then placed using the over-the-wire technique. Once the K-wire was removed, endoscopic graspers were used to biopsy the lesion through the angiocatheter, providing reasonably sized biopsy specimens.RESULTSThis technique was applied when fine needle aspiration failed and resulted in successful pathologic diagnosis.CONCLUSIONThis technique for minimally invasive biopsy of the cavernous sinus is potentially safe and can be performed when fine needle aspiration is unsuccessful or larger samples are required for definitive diagnosis.

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Endonasal, transmaxillary, transpterygoid approach to the foramen ovale: radio-anatomical study of surgical feasibility

The Journal of Laryngology & Otology ◽

10.1017/s0022215113002338 ◽

2013 ◽

Vol 127 (11) ◽

pp. 1093-1102 ◽

Cited By ~ 5

Author(s):

V E Kantola ◽

G W McGarry ◽

P M Rea

Keyword(s):

Computed Tomography ◽

Endoscopic Surgery ◽

Surgical Approach ◽

Image Guidance ◽

Anatomical Study ◽

Foramen Ovale ◽

Assisted Navigation ◽

Anterior Nasal Spine ◽

Computed Tomography Scans ◽

Pterygoid Plate

AbstractObjective:This study aimed to examine the feasibility of an endonasal, transmaxillary, transpterygoid approach to the foramen ovale by examining key anatomical, radiological and surgical landmarks.Method:Measurements were taken from 183 patients' computed tomography scans using BrainLAB iPlan 1.1 Cranial software. Endoscopic dissection was then carried out on a cadaver to assess surgical viability.Results:We found that the distances from the posterior maxillary wall to the foramen ovale and from the anterior nasal spine to the foramen ovale were statistically significantly larger in men than women. The distance from the base of the lateral pterygoid plate to the foramen ovale, and the angle between the foramen ovale, the anterior nasal spine and the sphenoid rostrum, were constant between the sexes. The importance of the lateral pterygoid plate in locating the foramen ovale was demonstrated.Conclusion:With the increasing popularity of image guidance and assisted navigation in endoscopic surgery, these findings increase anatomico-radiological understanding of the surgical approach investigated.

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AN ANATOMICAL STUDY OF FORAMEN OVALE WITH CLINICAL IMPLICATIONS

International Journal of Anatomy and Research ◽

10.16965/ijar.2018.375 ◽

2018 ◽

Vol 6 (4.2) ◽

pp. 5921-5925

Author(s):

Saurjyaranjan Das ◽

◽

Champatyray Sreepreeti ◽

Nayak Gyanaranjan ◽

◽

...

Keyword(s):

Anatomical Study ◽

Clinical Implications ◽

Foramen Ovale

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Comprehensive anatomy of the foramen ovale critical to percutaneous stereotactic radiofrequency rhizotomy: cadaveric study of dry skulls

Journal of Neurosurgery ◽

10.3171/2019.1.jns18899 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1414-1422

Author(s):

Adel Elnashar ◽

Smruti K. Patel ◽

Almaz Kurbanov ◽

Kseniya Zvereva ◽

Jeffrey T. Keller ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Facial Pain ◽

Preoperative Imaging ◽

Morphometric Study ◽

Microsurgical Anatomy ◽

Foramen Ovale ◽

Percutaneous Approach ◽

Head Ct ◽

Adjacent Structures ◽

Shape And Size

OBJECTIVEPercutaneous stereotactic radiofrequency rhizotomy (PSR) is often used to treat trigeminal neuralgia, a serious condition that results in lancinating, episodic facial pain. Thorough understanding of the microsurgical anatomy of the foramen ovale (FO) and its surrounding structures is required for efficient, effective, and safe use of this technique. This morphometric study compares anatomical and surgical orientations to identify the variations of the FO and assess cannulation difficulty.METHODSBilateral foramina from 174 adult human dry skulls (348 foramina) were analyzed using anatomical and surgical orientations in photographs from standardized projections. Measurements were obtained for shape, size, adjacent structures, and morphometric variability effect on cannulation. The risk of potential injury to surrounding structures was also assessed.RESULTSThe authors identified 6 distinctive shapes of the FO and 5 anomalous variants from the anatomical view, and 6 shapes from the surgical view. In measurements of surface area of this foramen obtained using the surgical view, loss (average 18.5% ± 5.7%) was significant compared with the anatomical view. Morphometrically, foramen size varied significantly and obstruction from a calcified pterygoalar ligament occurred in 7.8% of specimens. Importantly, 8% of foramina were difficult to cannulate, thus posing a 12% risk of inadvertent cannulation of the foramen lacerum.CONCLUSIONSSignificant variability in the FO’s shape and size probably affected its safe and effective cannulation. Preoperative imaging by 3D head CT may be helpful in predicting ease of cannulation and in guiding treatment decisions, such as a percutaneous approach over microvascular decompression or radiosurgery.

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An Anatomical Study of the Foramen Ovale for Neuromodulation of Trigeminal Neuropathic Pain

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13140 ◽

2020 ◽

Vol 23 (6) ◽

pp. 763-769

Author(s):

Ki‐Hyun Cho ◽

Hirsh A. Shah ◽

Tyler Schimmoeller ◽

Andre G. Machado ◽

Francis A. Papay

Keyword(s):

Neuropathic Pain ◽

Anatomical Study ◽

Foramen Ovale ◽

Trigeminal Neuropathic Pain

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Regional vascular relationships to the foramen ovale: an anatomical study with application to approaches to the external skull base with an emphasis on transcutaneous procedures for the treatment of trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2010.3.jns091454 ◽

2010 ◽

Vol 113 (3) ◽

pp. 493-497 ◽

Cited By ~ 2

Author(s):

R. Shane Tubbs ◽

Joshua Dixon ◽

Marios Loukas ◽

Aaron A. Cohen-Gadol

Keyword(s):

Skull Base ◽

Internal Carotid ◽

Statistical Significance ◽

Anatomical Study ◽

Middle Meningeal Artery ◽

Maxillary Artery ◽

Foramen Ovale ◽

Carotid Canal ◽

Vascular Structures ◽

The Mean

Object The foramen ovale and its neighboring vascular structures may be seen via external approaches to the skull base. More commonly, however, transcutaneous approaches to the foramen ovale are performed. Although complications with this latter technique are uncommon, studies of the distances to the surrounding extracranial vascular structures are lacking in the literature. The present study aimed to elucidate such anatomical relationships. Methods Twenty adult cadavers (40 sides) underwent dissection of the region surrounding the foramen ovale at the external skull base. Measurements between the external surface of the foramen ovale and surrounding vascular structures were made. Results From the nearest aspect of the undersurface of the foramen ovale, the authors found that the mean distances to the middle meningeal artery, maxillary artery, superior bulb of the internal jugular vein, and internal carotid artery at its entrance to and exit from the carotid canal were 3, 19, 20, 9, and 12 mm, respectively. Distances tended to be shorter in females, but this did not reach statistical significance. On the basis of these data, the authors also determined a safe zone while approaching the undersurface of the foramen ovale. Conclusions Additional knowledge of the neurovascular relationships surrounding the foramen ovale may be useful to the neurosurgeon and may help decrease the potential for complications.

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