The osseous structures in the infratemporal fossa: foramen ovale, bony spurs, ossified ligaments and their contribution to the trigeminal neuralgia

✓ The authors report their experience in the treatment of trigeminal neuralgia with controlled increments of radiofrequency heating from an electrode placed in the Gasserian ganglion or its posterior rootlets. Touch is preserved in some or all of a trigeminal zone rendered analgesic. The electrode tip is introduced through the foramen ovale and placed among the desired rootlets with the help of a combination of radiographs and the conscious patient's response to electrical stimulation with a square wave signal and gentle electrical heating. The degree of heat is measured by a thermister at the electrode tip. The patient's cooperation is maintained by the use of the neurolept anesthetic Innovar and the production of brief unconsciousness for the painful parts of the operation by methohexital (Brevital). Of 274 patients with facial pain so treated, 214 had trigeminal neuralgia; 91% of the latter group experienced relief of pain and 125 followed for 2½ to 6 years had a recurrence rate of 22%. In a total of 353 procedures, there has been no mortality and no neurological morbidity outside the trigeminal nerve. Only six of the patients with trigeminal neuralgia have complained significantly of postoperative paresthesias. The most serious undesired result has been the production of an anesthetic cornea in 28 patients, one of whom lost the sight of one eye due to corneal scarring. Correlating findings in our patients with those in studies by other authors, we conclude that the preservation of some touch is due to resistance to heating by the heavily myelinated A-beta fibers.

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Evaluation of Anatomoradiological Findings on Trigeminal Neuralgia Patients Using Computed Tomography and Cone-Beam Computed Tomography

Diagnostics ◽

10.3390/diagnostics12010073 ◽

2021 ◽

Vol 12 (1) ◽

pp. 73

Author(s):

Seçil Aksoy ◽

Arzu Sayın Şakul ◽

Durmuş İlker Görür ◽

Bayram Ufuk Şakul ◽

Kaan Orhan

Keyword(s):

Computed Tomography ◽

Trigeminal Neuralgia ◽

Cone Beam Ct ◽

Median Plane ◽

Cone Beam ◽

Foramen Ovale ◽

Percutaneous Procedures ◽

The Right ◽

And Control ◽

Supraorbital Foramen

The study aimed to establish and evaluate anatomoradiological landmarks in trigeminal neuralgia patients using computed tomography (CT) and cone-beam CT. CT images of 40 trigeminal neuralgia (TN) and 40 healthy individuals were retrospectively analyzed and enrolled in the study. The width and length of the foramen rotundum (FR), foramen ovale (FO), foramen supraorbitale, and infraorbitale were measured. The distances between these foramen, between these foramen to the median plane, and between the superior orbital fissure, FO, and FR to clinoid processes were also measured bilaterally. Variations were evaluated according to groups. Significant differences were found for width and length of the foramen ovale, length of the foramen supraorbitale, and infraorbitale between TN and control subjects (p < 0.05). On both sides, FO gets narrower and the length of the infraorbital and supraorbital foramen shortens in the TN group. In most of the control patients, the plane which passes through the infraorbital and supraorbital foramen intersects with impression trigeminale; 70% on the right-side, and 67% in the left-side TN groups. This plane does not intersect with impression trigeminale and deviates in certain degrees. The determination of specific landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures in trigeminal neuralgia patients.

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PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. Perforation of inferior alveolar nerve by maxillary artery

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v3.n3.13935 ◽

2016 ◽

Vol 3 (3) ◽

pp. 124-129

Author(s):

Prakash B Billakanti

Keyword(s):

Infratemporal Fossa ◽

Maxillofacial Surgery ◽

Inferior Alveolar Nerve ◽

Anatomical Variations ◽

Clinical Implications ◽

Maxillary Artery ◽

Foramen Ovale ◽

Anesthetic Agents ◽

Male Cadaver ◽

Anatomical Area

La fosa infratemporal es un área anatómica clínicamente importante para la administración de agentes anestésicos locales en odontología y cirugía maxilofacial. Fueron estudiadas variaciones en la anatomía del nervio alveolar inferior y la arteria maxilar en la disección infratemporal. Durante la disección rutinaria de la cabeza en el cadáver de un varón adulto, fue observada una variación excepcional en el origen del nervio alveolar inferior y su relación con las estructuras circundantes. El nervio alveolar inferior se originaba en el nervio mandibular por dos raíces y la primera parte de la arteria maxilar estaba incorporada entre ambas. El origen embriológico de esta variación y sus implicaciones clínicas es debatido. Dado que la arteria maxilar transcurría entre las dos raíces del nervio alveolar inferior, y el nervio estaba fijado entre el foramen oval y el foramen mandibular, el atrapamiento vásculo-nervioso pudo causar entume-cimiento o dolor de cabeza e interferir con la inyección de anestésicos locales en la fosa infratemporal. Variaciones anatómicas en esta región deben ser tenidas en cuenta, especialmente en casos de tratamiento fallido de neuralgia del trigémino. Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originated from the mandibular nerve by two roots and the first part of the maxillary artery was incorporated between them. An embryologic origin of this variation and its clinical implications is discussed. Because the maxillary artery runs between the two roots of the inferior alveolar nerve, and the nerve was fixed between the foramen ovale and mandibular foramen, neurovascular entrapment may cause pain numbness or headache and may interfere with the injection of local anesthetics into the infratemporal fossa. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.

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Unconventional Facial Entry Points Confirmed Using a 3D CT Reconstruction–Guided Stereotactic Approach to Radiofrequency Thermocoagulation for the Treatment of Trigeminal Neuralgia: A Series of Case Reports

Pain Medicine ◽

10.1093/pm/pny262 ◽

2018 ◽

Vol 20 (8) ◽

pp. 1551-1558 ◽

Cited By ~ 2

Author(s):

Zhigang Guo ◽

Zhijia Wang ◽

Kai Li ◽

Chao Du ◽

Xingli Zhao ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Anatomical Variation ◽

Preoperative Imaging ◽

Gasserian Ganglion ◽

Ct Reconstruction ◽

Foramen Ovale ◽

Radiofrequency Thermocoagulation ◽

Patient Reported ◽

Entry Points

Abstract Objectives Patients with trigeminal neuralgia who are refractory to medical therapy may choose to undergo Gasserian ganglion percutaneous radiofrequency thermocoagulation. However, in cases where the foramen ovale is difficult to access due to various anatomical anomalies, the typical estimation of the facial entry point is suboptimal. Methods Three-dimensional computed tomography reconstruction imaging performed before surgery revealed anatomical variations in each of the four adult patient cases that made it more difficult to successfully access the foramen ovale (FO) for percutaneous radiofrequency thermocoagulation. Using measurements collected from preoperative imaging that showed each specific anatomical variation in the FO, researchers marked alternate facial entry points that would allow successful probe placement into the FO and recorded the arc angle data in the stereotactic instrument. Results Patients were evaluated during follow-up visits ranging from seven to 26 months after surgery and asked to rate postoperative pain using a visual analog scale. These scores decreased from 10 to 3 in all four patients by the third day after the procedure. There were no permanent complications or morbidities from the surgery. One patient experienced mild facial numbness; however, this side effect subsided within three months after surgery. During the follow-up period, no patient reported pain recurrence. Conclusions The expectation for clinicians approaching trigeminal nerve block using a peri-oral approach should be to expect a great degree of potential variability in terms of both distances from the corner of the mouth and needle angle taken to successfully navigate the anatomy and access the foramen ovale.

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Precise Cannulation of the Foramen Ovale in Trigeminal Neuralgia Complicating Osteogenesis Imperfecta with Basilar Invagination: Technical Case Report

Neurosurgery ◽

10.1227/00006123-200004000-00049 ◽

2000 ◽

Vol 46 (4) ◽

pp. 1005-1008 ◽

Cited By ~ 1

Author(s):

Daniel Hajioff ◽

Neil L. Dorward ◽

John P. Wadley ◽

H. Alan Crockard ◽

James D. Palmer

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Osteogenesis Imperfecta ◽

Basilar Invagination ◽

Foramen Ovale

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Trigeminal neuralgia treated by differential percutaneous radiofrequency coagulation of the Gasserian ganglion

Journal of Neurosurgery ◽

10.3171/jns.1974.40.4.0517 ◽

1974 ◽

Vol 40 (4) ◽

pp. 517-523 ◽

Cited By ~ 66

Author(s):

G. Robert Nugent ◽

Bruce Berry

Keyword(s):

Trigeminal Neuralgia ◽

Percutaneous Penetration ◽

Anesthetic Techniques ◽

Gasserian Ganglion ◽

Foramen Ovale ◽

Content Type ◽

The Face ◽

Touch Sensation ◽

Radiofrequency Coagulation ◽

Radiographic Landmarks

✓ The authors describe surgical and anesthetic techniques for the treatment of trigeminal neuralgia by radiofrequency coagulation. Using radiographic landmarks derived from a stereotaxic study of 54 cadaver skulls, they delineate lateral and anteroposterior guidelines which aid in the percutaneous penetration of the foramen ovale. Controlled lesions can be made selectively in any division of the trigeminal nerve. The procedure has been effective in abolishing pain usually with preservation of touch sensation in the face. The percutaneous operation has the added advantage of a short hospitalization, usually 2 days. Of the 65 patients treated, only one still has the pain of trigeminal neuralgia. In six instances the procedure had to be repeated because insufficient sensory deficit was produced by the initial lesion. Three patients have developed anesthesia dolorosa; however, none has developed facial paralysis.

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Minimizing Technical Failure of Percutaneous Balloon Compression for Trigeminal Neuralgia Using Neuronavigation

ISRN Neurology ◽

10.1155/2014/630418 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Miltiadis Georgiopoulos ◽

John Ellul ◽

Elisabeth Chroni ◽

Constantine Constantoyannis

Keyword(s):

Trigeminal Neuralgia ◽

Navigation System ◽

Technical Failure ◽

Foramen Ovale ◽

Successful Cannulation ◽

Balloon Compression ◽

Percutaneous Balloon ◽

Safe Management ◽

Percutaneous Balloon Compression ◽

Head Computed Tomography

Objective. Percutaneous balloon compression (PBC) is an effective and safe management for medically refractory trigeminal neuralgia; however, technical failure to cannulate the foramen ovale (FO) using only fluoroscopy is a significant problem in some cases. In this paper, we suggest the use of intraoperative navigation, in cases of reoperation due to prior technical failure to cannulate the FO under fluoroscopy. Methods. A total of 174 patients underwent PBC for TN since 2003. In 9 cases the penetration of the FO was not accomplished. Five of those patients were reoperated on for PBC using navigation from March 2012 to September 2012. Surgical technique: preoperatively, a head Computed Tomography (CT) scan is performed and the acquired images are imported into the navigation system. Intraoperatively, a small reference frame is strapped firmly to the patient’s forehead, the CT images are registered, and cannulation is performed under the guidance of the navigation system. Results. In all patients, the operation overall was completed successfully. Moreover, all patients reported complete pain relief immediately postoperatively and no complications were recorded overall. Conclusions. We suggest the use of neuronavigation in cases of technical failure of PBC. That technique involves technology with significant advantages helping the successful cannulation of the FO and seems more efficient and safer.

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Technical Considerations for Facilitation of Selective Percutaneous Radiofrequency Neurolysis of the Trigeminal Nerve

Neurosurgery ◽

10.1097/00006123-197811000-00012 ◽

1978 ◽

Vol 3 (3) ◽

pp. 396-399 ◽

Cited By ~ 2

Author(s):

Ronald I. Apfelbaum

Keyword(s):

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Foramen Ovale ◽

Patient Preparation ◽

Electrode Positioning ◽

Technical Considerations

Abstract Fine points of the technique of selective percutaneous radiofrequency trigeminal neurolysis relative to patient preparation. accurate and rapid foramen ovale puncture, electrode positioning, and neurolytic lesions are discussed. These measures. which have evolved from our experience in treating trigeminal neuralgia by this method over the last 4 years, have made the procedure safer and less painful but also significantly more expedient.

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