Infratemporal Fossa Vascular Anatomy Pertinent to Percutaneous Access to the Foramen Ovale for Treatment of Trigeminal Neuralgia: A Comparison of Cadaveric Dissection and Computed Tomography Analysis

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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Computed Tomography Guidance for Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia

Operative Neurosurgery ◽

10.1093/ons/opz400 ◽

2019 ◽

Vol 19 (2) ◽

pp. E117-E121

Author(s):

Bradley T Schmidt ◽

Conrad D Pun ◽

Wendell B Lake ◽

Daniel K Resnick

Keyword(s):

Computed Tomography ◽

Trigeminal Neuralgia ◽

Radiation Exposure ◽

Skull Base ◽

Ct Guidance ◽

Foramen Ovale ◽

Ct Scanner ◽

Ct Guided ◽

Needle Position ◽

Scout Image

Abstract Background Percutaneous glycerol rhizotomy (PGR) is a well-described treatment for trigeminal neuralgia; however, the technique in using surface landmarks and fluoroscopy has not drastically changed since being first introduced. In this paper, we describe a protocol for PGR using computed tomography (CT) guidance based on an experience of over 7 yr and 200 patients. Objective To introduce an approach for PGR using CT guidance and, in doing so, demonstrate possible benefits over the traditional fluoroscopic technique. Methods Using a standard CT scanner, patients are placed supine with head in extension. Barium paste and a CT scout image are used to identify and plan a trajectory to the foramen ovale. A laser localization system built into the CT scanner helps to guide placement of the spinal needle into the foramen ovale. The needle position in the foramen is confirmed with a short-sequence CT scan. Results CT-guided PGR provides multiple benefits over standard fluoroscopy, including improved visualization of the skull base and significant reduction in radiation exposure to the surgeon and staff. Side benefits include improved procedure efficiency, definitive imaging evidence of correct needle placement, and potentially increased patient safety. We have had no significant complications in over 200 patients. CONCLUSION CT-guided PGR is a useful technique for treating trigeminal neuralgia based on better imaging of the skull base, better efficiency of the procedure, and elimination of radiation exposure for the surgeon and staff compared to traditional fluoroscopic based techniques.

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High-resolution computed tomography analysis of the medial infratemporal fossa: a pilot study

International Forum of Allergy & Rhinology ◽

10.1002/alr.21045 ◽

2012 ◽

Vol 2 (5) ◽

pp. 432-434 ◽

Cited By ~ 1

Author(s):

Jean Anderson Eloy ◽

Samuel A. Reyes ◽

Ross Germani ◽

James K. Liu ◽

Roy R. Casiano

Keyword(s):

Computed Tomography ◽

Pilot Study ◽

High Resolution ◽

Infratemporal Fossa ◽

High Resolution Computed Tomography ◽

Tomography Analysis

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A Novel Method of Locating Foramen Ovale for Percutaneous Approaches to the Trigeminal Ganglion

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e345 ◽

2019 ◽

Vol 4 (22;4) ◽

pp. E345-E350

Author(s):

Sung Hyun Lee

Keyword(s):

Computed Tomography ◽

Trigeminal Neuralgia ◽

Trigeminal Ganglion ◽

Surgical Approaches ◽

Fluoroscopic Guidance ◽

Foramen Ovale ◽

Anatomic Landmarks ◽

3 Dimensional ◽

Percutaneous Procedures ◽

Novel Method

Background: For patients with trigeminal neuralgia who do not respond to medication and for whom surgical approaches are too risky, percutaneous procedures targeting the trigeminal ganglion are the current standard treatment. Percutaneous procedures are performed via the transoval approach under radiologic guidance. Identification of the foramen ovale (FO) under fluoroscopic guidance is an important part of determining the success or failure of the procedures. Objectives: Previous studies have described how to visualize the FO under fluoroscopic guidance, but those methods are limited by poor reproducibility. In this study, we have investigated how to visualize the FO clearly and easily under fluoroscopic guidance. Study Design: Retrospective analysis. Setting: University hospital in Korea. Methods: Seventy-two 3-dimensional facial computed tomography scans without anatomic abnormalities of the skull base were analyzed for verifying the novel method. First, the mandibular angle and the occipital cortical line were overlapped and then turned by 15° oblique rotation using the software package. After these manipulations, the visualization of the FO was graded according to a 4-point scale (0: poor; 1: fair; 2: good; 3: excellent), and the inferior transfacial and oblique angles were measured. Results: This enabled clear visualization of the FO. The mean visual grade of 54 right and 46 left FO (total 100) was 2.74 (0: poor; 1: fair; 2: good; 3: excellent). All recorded FOs had at least grade 2 visibility. Limitations: This study is lacking application in clinical practice and comparative data to the submental view. Conclusions: The mandible angle and the occipital cortex line are obvious anatomic landmarks and are visible even to nonexperienced practitioners. Therefore, our method using these anatomic landmarks can improve the reproducibility and accuracy of FO visualization. Key words: Trigeminal neuralgia, foramen ovale, trigeminal ganglion, 3-dimensional (3D) facial computed tomography (CT) scans

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