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Kaye J, Ramanathan V, Sheehy JP, Andaluz N, Tew J, Forbes JA. Neuronavigation-Specific Parameters for Selective Access of Trigeminal Rootlets in Radiofrequency Lesioning: A Cadaveric Morphometric Study. Oper Neurosurg (Hagerstown) 2024; 27:220-227. [PMID: 38315010 DOI: 10.1227/ons.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Radiofrequency lesioning (RFL) is a safe and effective treatment for medically refractory trigeminal neuralgia. Despite gaining mainstream neurosurgical acceptance in the 1970s, the technique has remained relatively unchanged, with the majority of series using lateral fluoroscopy over neuronavigation for cannula guidance. To date, there are no studies describing neuronavigation-specific parameters to help neurosurgeons selectively target individual trigeminal rootlets. In this cadaveric study, we sought to provide a neuronavigation-specific morphometric roadmap for selective targeting of individual trigeminal rootlets. METHODS Embalmed cadaveric specimens were registered to cranial neuronavigation. Frontotemporal craniotomies were then performed to facilitate direct visualization of the Gasserian ganglion. A 19-gauge cannula was retrofit to a navigation probe, permitting real-time tracking. Using preplanned trajectories, the cannula was advanced through foramen ovale (FO) to the navigated posterior clival line (nPCL). A curved electrode was inserted to the nPCL and oriented inferolaterally for V3 and superomedially for V2. For V1, the cannula was advanced 5 mm distal to the nPCL and the curved electrode was reoriented inferomedially. A surgical microscope was used to determine successful contact. Morphometric data from the neuronavigation unit were recorded. RESULTS Twenty RFL procedures were performed (10R, 10L). Successful contact with V3, V2, and V1 was made in 95%, 90%, and 85% of attempts, respectively. Mean distances from the entry point to FO and from FO to the clival line were 7.61 cm and 1.26 cm, respectively. CONCLUSION In this proof-of-concept study, we found that reliable access to V1-3 could be obtained with the neuronavigation-specific algorithm described above. Neuronavigation for RFL warrants further investigation as a potential tool to improve anatomic selectivity, operative efficiency, and ultimately patient outcomes.
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Affiliation(s)
- Joel Kaye
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - Vishan Ramanathan
- University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - John P Sheehy
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - John Tew
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati , Ohio , USA
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2
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Morgan RD, Chintagunta A, Psaromatis KM, Vojtkofsky NA, Baronia B, Belirgen M. Seizure caused by intraparenchymal hemorrhage from migration of mandibular dental wire through foramen ovale in a child: A case report. Radiol Case Rep 2023; 18:3560-3564. [PMID: 37547795 PMCID: PMC10403720 DOI: 10.1016/j.radcr.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023] Open
Abstract
The foramen ovale is a structure that allows for the extracranial passage of multiple significant intracranial structures, most notably the mandibular branch of the trigeminal nerve (CN V3). Here we report the case of a 12-year-old male who presented to the emergency department (ED) with a two-day history of nausea and emesis and a one-day history of altered mental status. Prior to presentation, he started speaking only Spanish, which was unusual because he primarily speaks English. He was also showing signs of absence seizures. Computed Tomography (CT) showed his orthodontic wire had migrated and was entering his skull through the foramen ovale, terminating within the inferior temporal lobe. Associated with the wire was an intraparenchymal hemorrhage. Imaging indicated the sparing of the internal carotid artery and its major branches, suggesting the hemorrhage was likely venous in nature. The wire was then safely removed with no complications. Same day and follow-up neurologic exams all demonstrated no deficit in CN V3 or any of the other surrounding structures. To our knowledge, this is the first case described in the literature in which a foreign object penetrated the skull floor through the foramen ovale.
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Affiliation(s)
- Ryan D. Morgan
- School of Medicine, Texas Tech University Health Sciences Center Lubbock, 3601 4th St, Lubbock, TX 79430, USA
| | - Anila Chintagunta
- School of Medicine, Texas College of Osteopathic Medicine, Fort Worth, TX, USA
| | - Kirie M. Psaromatis
- School of Medicine, Texas Tech University Health Sciences Center Lubbock, 3601 4th St, Lubbock, TX 79430, USA
| | - Nicholas A. Vojtkofsky
- School of Medicine, Texas Tech University Health Sciences Center Lubbock, 3601 4th St, Lubbock, TX 79430, USA
| | - Benedicto Baronia
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Muhittin Belirgen
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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3
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Xu Y, El Ahmadieh TY, Nunez MA, Zhang Q, Liu Y, Fernandez-Miranda JC, Cohen-Gadol AA, Mao Y. Refining the Anatomy of Percutaneous Trigeminal Rhizotomy: A Cadaveric, Radiological, and Surgical Study. Oper Neurosurg (Hagerstown) 2023; 24:341-349. [PMID: 36716051 DOI: 10.1227/ons.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/06/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Percutaneous trigeminal rhizotomy (PTR) is a widely used procedure for trigeminal neuralgia. However, comprehensive analyses that combine anatomic, radiological, and surgical considerations are rare. OBJECTIVE To present high-quality anatomic dissections and radiological studies that highlight the technical nuances of this procedure. METHODS Six silicon-injected postmortem heads underwent PTR. The surgical corridors were dissected, and the neurovascular relationships were studied. In addition, 20 dried human skulls and 50 computed tomography angiography and MRI scans were collected to study the anatomic relationships for a customized puncture corridor. RESULTS The PTR corridor was divided into 3 segments: the buccal segment (length, 34.76 ± 7.20 mm), the inferior temporal fossa segment (length, 42.06 ± 6.92 mm), and the Meckel cave segment (length, 24.75 ± 3.34 mm). The puncture sagittal (α) and axial (β) angles measured in this study were 38.32° ± 4.62° and 19.13° ± 2.82°, respectively. The precondylar reference line coincided with the foramen ovale in 75% of the computed tomography angiography scans, and the postcondylar line coincided with the carotid canal in 70% of the computed tomography angiography scans; these lines serve as the intraoperative landmarks for PTR. The ovale-carotid-pterygoid triangle, delineated by drawing a line from the foramen ovale to the carotid canal and the lateral pterygoid plate, is a distinguished landmark to use for avoiding neurovascular injury during fluoroscopy. CONCLUSION Knowledge of the anatomic and radiological features of PTR is essential for a successful surgery, and a customized technical flow is a safe and effective way to access the foramen ovale.
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Affiliation(s)
- Yuanzhi Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Neurosurgery, Stanford Hospital, Stanford, California, USA.,Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Shanghai, China
| | - Tarek Y El Ahmadieh
- Neurosurgical-Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Qi Zhang
- Department of Cerebrovascular Diseases, Brain Hospital Affiliated to Tongji University, Shanghai, China
| | - Yaohua Liu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Juan Carlos Fernandez-Miranda
- Department of Neurosurgery, Stanford Hospital, Stanford, California, USA.,The Neurosurgical Atlas , Carmel, Indiana, USA
| | - Aaron A Cohen-Gadol
- The Neurosurgical Atlas , Carmel, Indiana, USA.,Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Shanghai, China
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Šink Ž, Umek N, Alibegović A, Cvetko E. Sphenoidal Foramen Ovale in the Slovenian Population: An Anatomical Evaluation with Clinical Correlations. Diagnostics (Basel) 2023; 13:diagnostics13050962. [PMID: 36900106 PMCID: PMC10000548 DOI: 10.3390/diagnostics13050962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/18/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
The foramen ovale (FO) is a crucial feature of the skull base, serving as a passage for clinically important neurovascular structures. The present study aimed to provide a comprehensive morphometric and morphologic analysis of the FO and highlight the clinical significance of the anatomical characterization. A total of 267 FO were analyzed in skulls obtained from deceased inhabitants of the Slovenian territory. The anteroposterior (length) and the transverse (width) diameters were measured using a digital sliding vernier caliper. Dimensions, shape, and anatomical variations of FO were analyzed. The mean length and width of the FO were 7.13 and 3.71 mm on the right side and 7.20 and 3.88 mm on the left side. The most frequently observed shape was oval (37.1%), followed by almond (28.1%), irregular (21.0%), D-shaped (4.5%), round (3.0%), pear-shaped (1.9%), kidney-shaped (1.5%), elongated (1.5%), triangular (0.7%), and slit-like (0.7%). In addition, marginal outgrowths (16.6%) and several anatomical variations were noted, including duplications, confluences, and obstruction due to a complete (5.6%) or incomplete (8.2%) pterygospinous bar. Our observations revealed substantial interindividual variation in the anatomical characteristics of the FO in the studied population, which could potentially impact the feasibility and safety of neurosurgical diagnostic and therapeutic procedures.
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Affiliation(s)
- Žiga Šink
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
- Correspondence: (Ž.Š.); (N.U.)
| | - Nejc Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
- Correspondence: (Ž.Š.); (N.U.)
| | - Armin Alibegović
- Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
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He LL, Zhao WX, Su PYP, Sun XR, Guo GL, Yue JN, Ni JX, Yang LQ, Guan Z. Identification of Foramen Ovale With H-Figure Fluoroscopic Landmark Improves Treatment Outcomes in Idiopathic Trigeminal Neuralgia. Anesth Analg 2022; 135:837-844. [PMID: 35426836 PMCID: PMC9495645 DOI: 10.1213/ane.0000000000005992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Because it is traditionally difficult and time-consuming to identify the foramen ovale (FO) with fluoroscopy, we recently developed the H-figure method to acquire fluoroscopic view of FO with shorter procedure time and less radiation. However, the impact of such an H-figure approach on the clinical outcomes of trigeminal ganglion radiofrequency thermocoagulation (RFT) in treating idiopathic trigeminal neuralgia (ITN) remains unclear. METHODS In a 12-month follow-up retrospective cohort study, patients with ITN had fluoroscopy-guided RFT of trigeminal ganglion via either classic approach (n = 100) or H-figure approach (n = 136) to identify FO. Data of continuous variables were analyzed with a Shapiro-Wilk test for normality and subsequently with a Mann-Whitney test, and the binary data were analyzed with a χ 2 test. The primary outcome was the facial pain measured by a Visual Analog Scale (VAS) 1 year after the treatment. The secondary outcomes included the quality of the fluoroscopic FO views, the threshold voltage to provoke paresthesia, the procedure time, the number of fluoroscopic images, and the facial numbness VAS. RESULTS Compared with the classic approach group, the H-figure approach group was associated with better long-term pain relief after the procedure, with significantly fewer patients had pain 3 months (6.6% vs 17.0%, P = .012) and 12 months (21.3% vs 38.0%, P = .005) after the procedure, and among patients who had pain after the procedure, patients in the H-figure group had significantly less pain 6 months after the procedure (VAS median [interquartile range (IQR)]: 3 [2-6] vs 6 [4-7], P < .001). Moreover, compared to the classic approach, the H-figure approach provided better fluoroscopic view of FO, lower threshold voltage to elicit paresthesia (median [IQR]: 0.2 [0.2-0.3] vs 0.4 [0.4-0.5] V, P < .0001), with shorter procedure time (median [IQR]: 7.5 [6.0-9.0] vs 14.0 [10.0-18.0] min, P < .0001), and required fewer fluoroscopic images (median [IQR]: 4.0 [3.0-5.0] vs 8.0 [6.0-10.0], P < .0001). CONCLUSIONS RFT of the trigeminal ganglion using the H-figure approach is associated with superior longer term clinical pain relief than the classic approach in treating ITN.
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Affiliation(s)
- Liang-Liang He
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
- These authors contributed equally to the work as co-first authors
| | - Wen-Xing Zhao
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- These authors contributed equally to the work as co-first authors
| | - Po-Yi Paul Su
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
- These authors contributed equally to the work as co-first authors
| | - Xin-Ran Sun
- Department of Pain treatment, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong Province, China
| | - Gui-Li Guo
- Stroke Acute Care Center, Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Jian-Ning Yue
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Jia-Xiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Li-Qiang Yang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- These authors contributed equally to the work as co-last authors
| | - Zhonghui Guan
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
- These authors contributed equally to the work as co-last authors
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6
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Dong FY, Zhan Q, Shao ZK, Gu Q, Gao XT, Zhou B, Li L, Ma YW, Wang XF, Liang YC. Clinical study on the treatment of primary trigeminal neuralgia by robot-assisted percutaneous balloon compression. Front Surg 2022; 9:1007818. [DOI: 10.3389/fsurg.2022.1007818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundC-arm-guided percutaneous puncture balloon compression alone has risk factors of puncture failure, complications, and poor prognosis. Robot-assisted PBC can effectively increase the one-time puncture success rate and improve the safety of the procedure. However, evidence on the superiority of robot-assisted PBC over C-arm-guided PBC alone remains relatively limited.MethodsRetrospective analysis The clinical data of 60 patients with trigeminal neuralgia aged 60 years or older in the Department of Neurosurgery of the Fourth Hospital of Harbin Medical University from January 2021 to October 2021. There were 29 males and 31 females, and the patients’ ages ranged from 60 to 79 years, with an average of 71.63 ± 5.12 years. Two groups were divided according to the surgical method, the C-arm guidance-only group (30 cases, n = 30) and the robot-assisted group (30 cases, n = 30). The success rate of first puncture, total operation time, number of “pear-shaped” balloons, number of C-arm x-ray scans, and immediate postoperative relief rate were recorded in both groups, and follow-up was performed to evaluate the postoperative results and complications. The overall evaluation of postoperative results and complications was performed.ResultsIntraoperative balloon compression was successfully completed in all 60 patients, and the first puncture success rate was higher in the robot-assisted group than in the simple C-arm group, with a significant difference between the two groups (P < 0.001). In terms of intraoperative balloon morphology, the number of “pear-shaped” balloons was higher in the PBC than in the C-arm-only PBC group, with a significant difference between the two groups (P < 0.005). The degree of immediate postoperative remission in the robotic group was 0 VAS score, which was not statistically significant in both groups (P > 0.05). By the final follow-up, the mean VAS score of the robot-assisted group was lower than that of the simple C-arm group, and both were statistically significant (P < 0.05); complications of masticatory muscle weakness or abnormal facial sensation occurred in both groups after surgery, but the number of cases in the robot-assisted group was less than that of the simple C-arm group.ConclusionRobot-assisted PBC is better than PBC with a C-arm x-ray machine in terms of first puncture success rate, number of intraoperative balloon “pear-shaped” cases, number of C-arm x-ray scans and short-term efficacy.
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7
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Peper C, Iwanaga J, Dumont AS, Tubbs RS. A giant foramen of Vesalius: case report. Anat Cell Biol 2022; 55:373-375. [PMID: 35692089 PMCID: PMC9519767 DOI: 10.5115/acb.22.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
Anatomical variations identified at the skull base can result in challenges to the clinician. For example, the anatomy of the foramen ovale and its neighboring structures is critical knowledge for the surgeon who performs transcutaneous approaches to the foramen ovale for treating patients with trigeminal neuralgia. One nearby structure that can compound invasive procedures and potentially result in complications is the foramen of Vesalius. Although usually small, we report a giant foramen of Vesalius found in an adult female skull. The anatomy and clinical aspects of such a finding are discussed and related to other reports in the literature.
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Affiliation(s)
- Charles Peper
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,University of Queensland, Brisbane, Australia
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8
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The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia. Acta Neurochir (Wien) 2022; 164:1575-1585. [PMID: 35484311 DOI: 10.1007/s00701-022-05224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Radiofrequency thermocoagulation trigeminal rhizotomy (RT-TR) through the foramen ovale is a minimally invasive treatment for trigeminal neuralgia. Navigation of magnetic resonance imaging (MRI) and CT fusion imaging is a well-established method for cannulation of the Gasserian ganglion. In this study, we use the inline measurements from fusion image to analyze the anatomical parameters between the actual and simulation trajectories and compare the short- and intermediate-term outcomes according to determinable factors. METHODS The study included thirty-six idiopathic neuralgia patients who had undergone RT-TR with MRI and CT fusion image as a primary modality or repeated procedures. RESULTS Among thirty-six treated patients, the inline length of the trigeminal cistern was longer for the simulated trajectory (8.4 ± 2.4 versus 6.5 ± 2.8 mm; p < 0.05), and the predominant structure at risk extrapolated from the inline trajectory was the brainstem, which signified a more medially directed route, in contrast with the equal weighting of temporal lobe and brainstem for the actual trajectory. The preoperative visual analogue scale (VAS) was 9.3 ± 1.0, which decreased to 2.5 ± 2.6 and 2.9 ± 3.1 at first (mean, 3 months) and second (mean, 14 months) postoperative follow-up, respectively. The postoperative VAS scores at the two follow-ups were not statistically significant without a covariate analysis. After adjustment for covariate risk factors, the second follow-up sustained therapeutic benefit was evident in patients with no prior history of related treatment, an ablation temperature greater than 70 °C, and needle location within or adjacent to the trigeminal cistern. CONCLUSIONS This preliminary study demonstrated that the needle location between cistern and ganglion also plays a significant role in better intermediate-term results.
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9
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Lawrence JD, Cheyuo C, Marsh RA. 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. World Neurosurg 2022; 160:e307-e313. [PMID: 35017076 PMCID: PMC9246507 DOI: 10.1016/j.wneu.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trigeminal neuralgia may be treated via percutaneous access to the foramen ovale (FO). Vascular complications associated with the needle trajectory can result in serious morbidity and mortality. This study aimed to correlate the vascular relationships of the FO at the skull base via cadaveric dissections and computed tomography (CT). METHODS Two fresh cadaver heads were injected with red and blue latex to delineate arteries and veins. Neck and infratemporal fossa dissections were carried out to delineate the vascular relationships of the FO. High-resolution head CT images of adult patients undergoing neurosurgical evaluations or procedures were analyzed for distances and sizes of skull base foramina in the infratemporal fossa. RESULTS Three infratemporal fossa dissections (2 cadaveric specimens) were performed. Mean distance of FO to internal carotid artery was 2.4 ± 0.12 cm, and mean distance of FO to middle meningeal artery was 0.8 ± 0.16 cm. Head CT images of 52 patients (104 sides) with 1-mm axial slice thickness were analyzed. Area of the FO was 31.1 ± 9.6 mm2. Distance of FO to internal carotid artery was 1.70 ± 0.31 cm, and distance of FO to middle meningeal artery was 0.73 ± 0.61 cm. CONCLUSIONS Cadaveric delineation of vascular structures in the infratemporal fossa correlates with head CT imaging and may be used to accurately plan percutaneous access to the FO. Inadvertent puncture of the extracranial internal carotid artery is nearly impossible with good technique. The most likely source of percutaneous vascular injury is the middle meningeal artery and distal branches of the maxillary artery.
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Affiliation(s)
- Jesse D Lawrence
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
| | - Cletus Cheyuo
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Robert A Marsh
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
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10
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Guo W, Shi H, Wen X, Qian T. A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion. Oper Neurosurg (Hagerstown) 2022; 22:315-321. [PMID: 35240674 DOI: 10.1227/ons.0000000000000123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The classic puncture method of percutaneous microcompression using fluoroscopy might be difficult to precisely locate and visualize the foramen ovale. Various new surgical tools to increase the accuracy of finding the foramen ovale location have been introduced. However, all of these systems require some complicated operating steps and/or advanced devices to complete the work. OBJECTIVE To describe the use of a simple method for foramen ovale puncture by percutaneous microcompression based on preoperative image simulation. METHODS Forty-five patients were included in the study. All patients underwent a computed tomography examination. Among them, the simulated preoperative puncture pathway was reconstructed on the basis of computed tomography scan examination for 22 patients. Procedures were performed by 2 surgeons: one experienced surgeon and another young surgeon with surgical qualification. The puncturing time and cumulative radiation exposure dose, from start of the puncturing until reaching the foramen ovale, were recorded. Postoperative pain relief, facial hypoesthesia, masticatory muscle weakness, and other complications were recorded. RESULTS In all cases, the procedure of cannulation was completed successfully. The puncturing time for both the experienced and young surgeon with the use of preoperative image simulation seemed to be time-saving. The young surgeon had less cumulative radiation exposure with the use of preoperative image simulation. Moreover, the intraoperative puncture pathways were almost consistent with the preoperative simulated images. The rest of the process went smoothly. Short-term outcomes of all the 45 patients were satisfactory. CONCLUSION Based on our preliminary experience, the preoperative image simulation-guided technique is useful during these cases.
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Affiliation(s)
- Wenchang Guo
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, China
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Sthapak E, Pasricha N, Singh A, Bhatnagar R, Bedi R. Foramen ovale and associated accessory foramina: A computerized tomography study to determine morphometry and analyze gender and age differences. NATIONAL JOURNAL OF CLINICAL ANATOMY 2022. [DOI: 10.4103/njca.njca_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Aksoy S, Sayın Şakul A, Görür Dİ, Şakul BU, Orhan K. Evaluation of Anatomoradiological Findings on Trigeminal Neuralgia Patients Using Computed Tomography and Cone-Beam Computed Tomography. Diagnostics (Basel) 2021; 12:diagnostics12010073. [PMID: 35054240 PMCID: PMC8775053 DOI: 10.3390/diagnostics12010073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Seçil Aksoy
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Near East University, Mersin 10, Lefkosa 99138, Turkey
- Correspondence: ; Tel.: +90-3926802030; Fax: +90-3926802025
| | - Arzu Sayın Şakul
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey;
| | - Durmuş İlker Görür
- Department of Oral and Maxillofacial Surgery, Dentiron Private Clinic, Ankara 06690, Turkey;
| | - Bayram Ufuk Şakul
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey;
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06100, Turkey;
- Medical Design Application and Research Center (MEDITAM), Ankara University, Ankara 06100, Turkey
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, 20-081 Lublin, Poland
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13
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Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res 2021; 14:3437-3463. [PMID: 34764686 PMCID: PMC8572857 DOI: 10.2147/jpr.s331036] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Trigeminal neuralgia (TN) has been described in the literature as one of the most debilitating presentations of orofacial pain. This review summarizes over 150 years of collective clinical experience in the medical and surgical treatment of TN. Fundamentally, TN remains a clinical diagnosis that must be distinguished from other types of trigeminal neuropathic pain and/or facial pain associated with other neuralgias or headache syndromes. What is increasingly clear is that there is no catch-all medical or surgical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that TN is likely a heterogenous group of disorders that jointly manifests in facial pain. The first-line treatment for TN remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them. In general, microvascular decompression is a safe and effective procedure with immediate and durable outcomes. Patients who are unable to tolerate general anesthesia or whose medical comorbidities preclude a suboccipital craniectomy may benefit from percutaneous methodologies including glycerol or radiofrequency ablation, or both. For patients with bleeding diathesis due to blood thinning medications who are ineligible for invasive procedures, or for those who are unwilling to undergo open surgical procedures, radiosurgery may be an excellent option-provided the patient understands that maximum pain relief will take on the order of months to achieve. Finally, peripheral neurectomies continue to provide an inexpensive and resource-sparing alternative to pain relief for patients in locations with limited economic and medical resources. Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Rau A, Roelz R, Urbach H, Coenen VA, Demerath T, Reinacher PC. Application of Augmented Reality in Percutaneous Procedures-Rhizotomy of the Gasserian Ganglion. Oper Neurosurg (Hagerstown) 2021; 21:160-164. [PMID: 34098574 PMCID: PMC8555421 DOI: 10.1093/ons/opab155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/14/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Percutaneous rhizotomy of the Gasserian ganglion for trigeminal neuralgia is an effective therapeutic procedure. Yet, landmark-guided cannulation of the foramen ovale is manually challenging and difficult to learn. OBJECTIVE To overcome these limitations, we assessed the feasibility and accuracy of an augmented reality (AR)-guided puncture of the foramen ovale. METHODS A head phantom with soft tissue structures of the facial area was built. A three-dimensional (3D)-dataset of the phantom was generated using a stereotactic planning workstation. An optimal trajectory to the foramen ovale was created and then transferred to an AR headset. A total of 2 neurosurgeons and 2 neuroradiologists independently performed 8 AR-guided and 8 landmark-guided cannulations of the foramen ovale, respectively. For each AR-guided cannulation, the hologram was manually aligned with the phantom. Accuracy of the cannulation was evaluated using the Euclidean distance to the target point as well as the lateral deviation of the achieved trajectory from the planned trajectory at target point level. RESULTS With the help of AR guidance, a successful cannulation of the foramen ovale was achieved in 90.6% compared to the purely landmark-based method with 18.8%. Euclidean distance and lateral deviation were significantly lower with AR guidance than landmark guidance (P < .01). CONCLUSION AR greatly improved accuracy of simulated percutaneous rhizotomy of the Gasserian ganglion.
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Affiliation(s)
- Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roland Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
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15
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CT Evaluation of Variations in the Middle Cranial Fossa Foramina: A Potential Guide for Skull Base Surgery. J Comput Assist Tomogr 2021; 45:586-591. [PMID: 34176882 DOI: 10.1097/rct.0000000000001178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate and classify the variations of foramen ovale (FO), foramen spinosum (FS). METHODS Six hundred fifty-eight computed tomographies (CTs) were evaluated by 2 observers. Foramen ovale was classified as oval, almond, round, and slit-like. Duplication, absence, and confluence for FS were noted. Bony outgrowths were categorized as tubercule, bony plate, and spine. RESULTS Oval shaped FO was the most common subgroup. Most common FS variation was the confluence with FO. Of bony outgrowths, tubercule-shaped were the most common type and spine-shaped ones were the least. Substantial agreement for bony plate and tubercule, almost excellent agreement for all the other parameters were found between 2 observers. CONCLUSIONS Foramen ovale called lobulated and had not classified previously was described in this study. Computed tomography is a reliable tool for anatomical evaluation of FO and FS, which would effect the methods of middle cranial fossa surgery. Thus, radiologists should be a pathfinder about the variations of these structures.
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He L, Zhao W, Su PYP, Guo G, Yue J, Ni J, Yang L, Guan Z. Novel fluoroscopic landmark to significantly facilitate the visualization of foramen ovale in treating idiopathic trigeminal neuralgia. Reg Anesth Pain Med 2020; 46:350-353. [PMID: 33328267 DOI: 10.1136/rapm-2020-102081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Access through the foramen ovale (FO) is essential in performing trigeminal ganglion injection, glycerol rhizolysis, balloon compression, and radiofrequency thermocoagulation (RFT) to treat idiopathic trigeminal neuralgia (ITN). However, identification of the FO under fluoroscopy can be difficult and time-consuming, and thus exposes patients to increased radiation and procedure risks. Here we present the 'H-figure' as a novel fluoroscopic landmark to quickly visualize the FO. METHODS The H-figure landmark can be recognized as the medial border of the mandible and the lateral edge of the maxilla as the two vertical lines, and the superior line of petrous ridge of temporal bone (S-P-T line) as the horizontal line, and the FO fluoroscopic view is then optimized at the center of the H-figure immediately above the S-P-T line. We applied this landmark in a clinical cohort of 136 patients with ITN who underwent fluoroscopy-guided RFT of the trigeminal ganglion. We also compared the H-figure method with the traditional method. The primary outcome was the total number of fluoroscopic images required to visualize the FO (as a proxy of radiation exposure). Secondary measures included the procedure time required to finalize the FO view and the sensory testing voltage for paresthesia. RESULTS With the H-figure approach we were able to view the FO with an average of 4.2 fluoroscopic shots at an average time of 6.8 min. When compared with the non-H-figure traditional technique, the H-figure method required almost half the fluoroscopic shots in nearly half the procedure duration time, and paresthesia was evoked with half of the voltage. CONCLUSION The H-figure is an easy fluoroscopic landmark that can help to view the FO with less radiation and procedure time, and the needles placed with this approach can be closer to the target for the RFT treatment of patients with ITN.
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Affiliation(s)
- Liangliang He
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
- Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - WenXing Zhao
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine,Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - Po-Yi Paul Su
- Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Guili Guo
- Stroke Acute Care Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianning Yue
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqiang Yang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhonghui Guan
- Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
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17
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Mendes PD, Martins da Cunha PH, Monteiro KDKO, Quites LV, Fonseca Filho GDA. Percutaneous Foramen Ovale Puncture: Usefulness of Intraoperative CT Control, in the Eventuality of a Narrow Foramen. Stereotact Funct Neurosurg 2020; 99:75-78. [PMID: 32937630 DOI: 10.1159/000509821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Balloon compression of the gasserian ganglion has been a well-established percutaneous treatment of trigeminal neuralgia since the 1980s. However, puncture of the foramen ovale by conventional single-plane fluoroscopy can be difficult in cases of local anatomic abnormalities. CASE PRESENTATION We present the case of a 49-year-old woman diagnosed with idiopathic trigeminal neuralgia refractory to pharmacological treatment. After failure of puncture by conventional fluoroscopy for percutaneous gasserian ganglion balloon compression due to a narrow foramen ovale, the patient was submitted to puncture guided by computed tomography. CONCLUSION Alternative imaging methods, such as computed tomography, should be considered when puncture of the foramen ovale by conventional single-plane fluoroscopy fails, to minimize the risk of potential complications triggered by frustrated puncture attempts.
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Affiliation(s)
- Plinio Duarte Mendes
- Division of Functional Neurosurgery, Department of Neurosurgery, Lifecenter Hospital, Belo Horizonte, Brazil, .,Division of Functional Neurosurgery, Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil,
| | - Pedro Henrique Martins da Cunha
- Division of Functional Neurosurgery, Department of Neurosurgery, Lifecenter Hospital, Belo Horizonte, Brazil.,Division of Functional Neurosurgery, Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil
| | | | - Lucas Viana Quites
- Division of Functional Neurosurgery, Department of Neurosurgery, Lifecenter Hospital, Belo Horizonte, Brazil
| | - Gilberto de Almeida Fonseca Filho
- Division of Functional Neurosurgery, Department of Neurosurgery, Lifecenter Hospital, Belo Horizonte, Brazil.,Division of Functional Neurosurgery, Department of Neurosurgery, Biocor Institute, Nova Lima, Brazil
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18
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Morphology and morphometry of the foramen venosum: a radiographic study of CBCT images and literature review. Surg Radiol Anat 2020; 42:779-790. [DOI: 10.1007/s00276-020-02450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
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19
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Matys T, Ali T, Zaccagna F, Barone DG, Kirollos RW, Massoud TF. Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy. J Neurosurg 2020; 132:1942-1951. [PMID: 31075780 DOI: 10.3171/2019.2.jns182709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ossification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and impede transzygomatic surgical approaches. Presence of these ligaments has been studied on dry skulls, but description of their radiological anatomy is scarce, in particular on cross-sectional imaging. The aim of this study was to describe visualization of pterygoalar and pterygospinous bars on computed tomography (CT) and to review their prevalence and clinical significance. METHODS The authors retrospectively reviewed 200 helical sinonasal CT scans by analyzing 0.75- to 1.0-mm axial images, maximum intensity projection (MIP) reconstructions, and volume rendered (VR) images, including views along the anticipated axis of the needle in percutaneous Hartel and submandibular approaches to the FO. RESULTS Ossified pterygoalar and pterygospinous ligaments were readily identifiable on CT scans. An ossified pterygoalar ligament was demonstrated in 10 patients, including 1 individual with bilateral complete ossification (0.5%), 4 patients with unilateral complete ossification (2.0%), and 5 with incomplete unilateral ossification (2.5%). Nearly all patients with pterygoalar bars were male (90%, p < 0.01). An ossified pterygospinous ligament was seen in 35 patients, including 2 individuals with bilateral complete (1.0%), 8 with unilateral complete (4%), 8 with bilateral incomplete (4.0%), 12 with bilateral incomplete (6.0%) ossification, and 5 (2.5%) with mixed ossification (complete on one side and incomplete on the contralateral side). All pterygoalar bars interfered with a hypothetical needle access to the FO using the Hartel approach but not the submandibular approach. In contrast, 54% of complete and 24% of incomplete pterygospinous bars impeded the submandibular approach to the FO, without affecting the Hartel approach. CONCLUSIONS This study provides the first detailed description of cross-sectional radiological and applied surgical anatomy of pterygoalar and pterygospinous bars. Our data are clinically useful during skull base imaging to predict potential obstacles to percutaneous cannulation of the FO and assist in the choice of approach, as these two variants differentially impede the Hartel and submandibular access routes. Our results can also be useful in planning surgical approaches to the skull base through the infratemporal fossa.
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Affiliation(s)
- Tomasz Matys
- 1Section of Neuroradiology, Department of Radiology, University of Cambridge, Biomedical Campus, Cambridge
- Departments of2Radiology and
| | | | - Fulvio Zaccagna
- 1Section of Neuroradiology, Department of Radiology, University of Cambridge, Biomedical Campus, Cambridge
| | - Damiano G Barone
- 3Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ramez W Kirollos
- 3Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- 4Department of Neurosurgery, National Neuroscience Institute, Singapore; and
| | - Tarik F Massoud
- 5Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California
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20
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Vance AZ, El Ahmadieh TY, Christian Z, Aoun SG, Barnett SL, White JA. Biplane Fluoroscopic-Guided Balloon Rhizotomy for Trigeminal Neuralgia: A Technical Note. Oper Neurosurg (Hagerstown) 2020; 18:295-301. [PMID: 31232436 DOI: 10.1093/ons/opz132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The classic percutaneous technique used to cannulate the foramen ovale for the treatment of trigeminal neuralgia can place important anatomic structures, such as the distal cervical internal carotid artery, at risk. OBJECTIVE To use fixed anatomic landmarks to safely and reliably locate the foramen ovale on anteroposterior (AP) fluoroscopy. METHODS Locating the foramen ovale was initially tested using AP fluoroscopy on cadaveric skulls in the neurosurgical simulation lab. Fluoroscopic landmarks were identified and utilized to assist in successfully locating the foramen ovale during percutaneous balloon rhizotomy procedures in patients with trigeminal neuralgia. This technique has been successfully used in multiple patients. In this report, we describe our technique in detail. RESULTS The AP fluoroscopy is directed laterally in the coronal plane until a line drawn inferiorly from the lateral orbital rim bisects the inner concavity of the mandibular angle. Fluoroscopy is then directed inferiorly until the top of the petrous ridge bisects the mandibular ramus. The foramen ovale will come into view within the window between the mandibular ramus and hard palate. Two case illustrations are provided. CONCLUSION Balloon rhizotomy is a commonly used treatment option for trigeminal neuralgia. Direct visualization of the foramen ovale can reliably be achieved on AP fluoroscopy using specific anatomic landmarks. This technique can be utilized to increase the accuracy and safety of the procedure.
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Affiliation(s)
- Awais Z Vance
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zachary Christian
- Department of Neurological Surgery, The University of Texas Southwestern, School of Medicine, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samuel L Barnett
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan A White
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Zdilla MJ, Ritz BK, Nestor NS. Locating the foramen ovale by using molar and inter-eminence planes: a guide for percutaneous trigeminal neuralgia procedures. J Neurosurg 2020; 132:624-630. [PMID: 30771764 DOI: 10.3171/2018.11.jns182276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The first attempt to cannulate the foramen ovale is oftentimes unsuccessful and requires subsequent reattempts, thereby increasing the risk of an adverse event and radiation exposure to the patient and surgeon. Failure in cannulation may be attributable to variation in soft-tissue-based landmarks used for needle guidance. Also, the incongruity between guiding marks on the face and bony landmarks visible on fluoroscopic images may also complicate cannulation. Therefore, the object of this study was to assess the location of the foramen ovale by way of bony landmarks, exclusive of soft-tissue guidance. METHODS A total of 817 foramina ovalia (411 left-sided, 406 right-sided) from cranial base images of 424 dry crania were included in the study. The centroid point of each foramen ovale was identified. A sagittal plane through the posterior-most molar (molar plane) and a coronal plane passing through the articular eminences of the temporal bones (inter-eminence plane) were superimposed on images. The distances of the planes from the centroids of the foramina were measured. Also, counts were taken to assess how often the planes and their intersections crossed the boundary of the foramen ovale. RESULTS The average distance between the molar plane and the centroid of the foramen was 1.53 ± 1.24 mm (mean ± SD). The average distance between the inter-eminence plane and the centroid was 1.69 ± 1.49 mm. The molar and inter-eminence planes crossed through the foramen ovale boundary 83.7% (684/817) and 81.6% (667/817) of the time, respectively. The molar and inter-eminence planes passed through the boundary of the foramen together 73.5% (302/411) of the time. The molar and inter-eminence planes intersected within the boundary of the foramen half of the time (49.4%; 404/817). CONCLUSIONS The results of this study provide a novel means of identifying the location of the foramen ovale. Unlike the soft-tissue landmarks used in the many variations of the route of Härtel, the bony landmarks identified in this study can be palpated, marked on the face, appreciated fluoroscopically, and do not require any measurement from soft-tissue structures. Utilizing the molar and inter-eminence planes as cannulation guides will improve the approach to the foramen ovale and decrease the amount of radiation exposure to both the patient and surgeon.
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Affiliation(s)
- Matthew J Zdilla
- Departments of1Natural Sciences and Mathematics and
- 2Graduate Health Sciences, West Liberty University, West Liberty; and
- 3Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, West Virginia
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Leonel LCPC, Peris‐Celda M, Sousa SDG, Haetinger RG, Liberti EA. The sphenoidal emissary foramen and the emissary vein: Anatomy and clinical relevance. Clin Anat 2019; 33:767-781. [DOI: 10.1002/ca.23504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/01/2019] [Accepted: 10/12/2019] [Indexed: 12/25/2022]
Affiliation(s)
| | - Maria Peris‐Celda
- Department of NeurosurgeryAlbany Medical Center Albany New York USA
- Northeast Professor Rhoton Surgical Anatomy Laboratory, Department of Neuroscience and Experimental TherapeuticsAlbany Medical Center Albany New York USA
- Department of Neurologic SurgeryMayo Clinic Rochester Minnesota USA
- Mayo Clinic Skull Base Research LaboratoryMayo Clinic Rochester Minnesota USA
| | - Severino Denicio Gonçalves Sousa
- Department of Surgery, Sector of AnatomySchool of Veterinary Medicine and Animal Science, University of São Paulo São Paulo Brazil
- Departamento de Ciências Básicas da VidaUniversidade Federal de Juiz de Fora – Campus Governador Valadares, Minas Gerais Brasil
| | | | - Edson Aparecido Liberti
- Department of Surgery, Sector of AnatomySchool of Veterinary Medicine and Animal Science, University of São Paulo São Paulo Brazil
- Department of AnatomyInstitute of Biomedical Sciences, University of São Paulo São Paulo Brazil
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23
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Tsai PJ, Lee MH, Chen KT, Huang WC, Yang JT, Lin MHC. Foramen ovale cannulation guided by intraoperative computed tomography with magnetic resonance image fusion plays a role in improving the long-term outcome of percutaneous radiofrequency trigeminal rhizotomy. Acta Neurochir (Wien) 2019; 161:1427-1434. [PMID: 31098700 PMCID: PMC6581933 DOI: 10.1007/s00701-019-03941-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/03/2019] [Indexed: 11/24/2022]
Abstract
Background Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) is a well-established treatment for patients suffering from trigeminal neuralgia (TN) as a primary modality or for those refractory to medical treatment. However, few existing studies have identified intraoperative parameter or navigation technique that can be used to predict the rates of short-term or long-term pain relief. In this study, we analyzed patient characteristics, intraoperative parameters and technical factors, and postoperative changes in relation to immediate and long-term pain relief. Method This study included a total 252 patients in which 340 RF-TR were performed under the guidance of intraoperative computed tomography (iCT) alone or with magnetic resonance image (MRI) and iCT fusion imaging. Result The immediate pain relief of RF-TR with iCT alone and iCT with MR image guidance with or without cerebrospinal fluid (CSF) outflow were all above 90.4%. The 2-year pain relief rate of RF-TR using iCT alone and iCT with MR images guidance with or without CSF outflow were 47.8%, 39.8%, 71.7%, and 53.9% respectively. Significant factors for 2-year pain relief were CSF outflow, iCT with MR image fusion, non-recurrent TN, and presence of postoperative facial numbness. Conclusion This preliminary study demonstrated foramen ovale cannulation under the aid of iCT with MR image guidance could improve 2-year pain relief.
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Electromagnetic neuronavigation for the percutaneous treatment of trigeminal neuralgia with balloon compression: technical note and cadaveric validation study. Acta Neurochir (Wien) 2018; 160:1337-1341. [PMID: 29675717 DOI: 10.1007/s00701-018-3548-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Several techniques have been described for the percutaneous treatment of trigeminal neuralgia; however, each has significant drawbacks. We propose a new technique for percutaneous balloon compression of the trigeminal ganglion and distal trigeminal nerve using electromagnetic (EM) neuronavigation. METHODS The procedure was performed in 17 consecutive patients with trigeminal neuralgia. Patients were then followed up with telephone interview. We also performed a cadaveric validation study to further investigate the accuracy of the technique using dye. RESULTS Excellent clinical outcomes were achieved with a reduction in the median pain score from 10 out of 10 to 0 out of 10 following the procedure. The cadaveric study also demonstrated a high rate of foramen ovale cannulation. CONCLUSION EM-based targeting of the foramen ovale and balloon inflation within Meckel's cave is a quick, reproducible and straightforward technique for the percutaneous treatment of trigeminal neuralgia.
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Edwards B, Wang JM, Iwanaga J, Loukas M, Tubbs RS. Cranial Nerve Foramina Part I: A Review of the Anatomy and Pathology of Cranial Nerve Foramina of the Anterior and Middle Fossa. Cureus 2018; 10:e2172. [PMID: 29644159 PMCID: PMC5889149 DOI: 10.7759/cureus.2172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cranial nerve foramina are integral exits from the confines of the skull. Despite their significance in cranial nerve pathologies, there has been no comprehensive anatomical review of these structures. Owing to the extensive nature of this topic, Part I of our review, presented here, focuses on the foramina of the anterior and middle cranial fossae, discussing each foramen's shape, orientation, size, surrounding structures, and structures that traverse them. Furthermore, by comparing the size of each foramen against the cross-sectional areas of its contents, we estimate the amount of free space in each. We also review lesions that can obstruct the foramina and discuss their clinical consequences.
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Affiliation(s)
- Bryan Edwards
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Joy Mh Wang
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
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Alves N, Deana NF. Anatomical study of the Foramen Venosum and its clinical implications. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Qureshi AI, Saleem MA, Jadhav V, Wallery SS, Raja F. Intra-arterial Modulation of the Trigeminal Nerve Ganglion in Patients with Refractory Trigeminal Neuralgia. J Neuroimaging 2017; 28:79-85. [DOI: 10.1111/jon.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute; St Cloud MN
- University of Illinois and Mercyhealth; Rockford IL
| | - Muhammad A. Saleem
- Zeenat Qureshi Stroke Institute; St Cloud MN
- University of Illinois and Mercyhealth; Rockford IL
| | | | | | - Faisal Raja
- University of Illinois and Mercyhealth; Rockford IL
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Bhatjiwale MG, Bhatjiwale MM, Bhagat A. Ultra-extended euthermic pulsed radiofrequency for the treatment of ophthalmic neuralgia: A case report with elaboration of a new technique. Surg Neurol Int 2016; 7:S818-S823. [PMID: 27990312 PMCID: PMC5134110 DOI: 10.4103/2152-7806.194062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 07/08/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pulsed radiofrequency although present for many years has been used little compared to ablative procedures for pain relief. Its use in trigeminal neuralgia is sparse and unreported in the ophthalmic division, where the possibility of sensory loss can lead to high morbidity. We wished to explore the potential of this reportedly safe modality for a prolonged duration in a highly sensitive anatomic neural location, however, in a very secure, structured, and staged manner. CASE DESCRIPTION A patient suffering from ophthalmic division (V1) medically uncontrolled neuralgia with a preoperative visual analog scale (VAS) score of 9/10 was subjected to a percutaneous pain relief procedure. The patient was treated with prolonged duration pulsed radiofrequency (PRF) for 40 min, with corneal sensation monitoring under conscious sedation keeping a low voltage (7 V) and tip temperature at 37°C. The patient obtained immediate relief, which was verified on the operation table itself. Postoperative VAS score of 0/10 was recorded. More than 6 months after the procedure, the patient is completely free from neuralgic pain and continues to have a VAS score of 0/10. CONCLUSION As opposed to conventional PRF where mostly a tip temperature of 42°C and high voltage have been used for 2 to a maximum of 8 min, PRF with a tip temperature of 37°C and a safe voltage of 7 V over an ultra-extended duration of 40 min can give a more distinct and effective but equally safe result. Although our case verified the safety and efficacy of prolonged duration PRF in sensitive anatomic locations, more studies are warranted for establishing this as a standard line of treatment. The specific use of PRF in ophthalmic division neuralgia in the manner described in our case report has hitherto not been reported in medical literature and will open a new vista in the minimally invasive treatment of this disease.
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Affiliation(s)
- Mohinish G. Bhatjiwale
- Department of Neurosurgery, Nanavati Superspeciality and Navneet Hi Tech Hospitals, Mumbai, Maharashtra, India
| | - Mrudul M. Bhatjiwale
- King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Ami Bhagat
- Navneet Hi Tech Hospitals, Mumbai, Maharashtra, India
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Zdilla MJ, Hatfield SA, Mangus KR. Angular Relationship Between the Foramen Ovale and the Trigeminal Impression: Percutaneous Cannulation Trajectories for Trigeminal Neuralgia. J Craniofac Surg 2016; 27:2177-2180. [PMID: 28005784 PMCID: PMC5266502 DOI: 10.1097/scs.0000000000003138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The debilitating pain of trigeminal neuralgia often necessitates neurosurgical intervention via percutaneous transovale cannulation. While most percutaneous treatments of trigeminal neuralgia are successful, severe adverse events resulting from failure to properly cannulate the foramen ovale (FO) have been reported. With regard to specific targeting of particular trigeminal divisions (ie, V1, V2, V3, and combinations thereof), operative techniques have been described; however, these descriptions have not included specific angulation data. This anatomic study analyzed the angular relationship between the centroid and anteromedial- and posterolateral-most aspects of the FO and the boundaries of the trigeminal impression. The study is the first to detail the angular relationship between the FO boundaries and the boundaries of the trigeminal impression in dry human skulls relative to the coronal plane. The information may be used to prevent miscannulation and also target specific branches of the trigeminal nerve for optimal operative results.
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Affiliation(s)
- Matthew J. Zdilla
- Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, West Virginia, USA
- Department of Graduate Health Sciences, West Liberty University, West Liberty, West Virginia, USA
| | - Scott A. Hatfield
- Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, West Virginia, USA
| | - Kelsey R. Mangus
- Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, West Virginia, USA
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Shakur SF, Luciano CJ, Kania P, Roitberg BZ, Banerjee PP, Slavin KV, Sorenson J, Charbel FT, Alaraj A. Usefulness of a Virtual Reality Percutaneous Trigeminal Rhizotomy Simulator in Neurosurgical Training. Neurosurgery 2016; 11 Suppl 3:420-5; discussion 425. [PMID: 26103444 DOI: 10.1227/neu.0000000000000853] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Simulation-based training may be incorporated into neurosurgery in the future. OBJECTIVE To assess the usefulness of a novel haptics-based virtual reality percutaneous trigeminal rhizotomy simulator. METHODS A real-time augmented reality simulator for percutaneous trigeminal rhizotomy was developed using the ImmersiveTouch platform. Ninety-two neurosurgery residents tested the simulator at American Association of Neurological Surgeons Top Gun 2014. Postgraduate year (PGY), number of fluoroscopy shots, the distance from the ideal entry point, and the distance from the ideal target were recorded by the system during each simulation session. Final performance score was calculated considering the number of fluoroscopy shots and distances from entry and target points (a lower score is better). The impact of PGY level on residents' performance was analyzed. RESULTS Seventy-one residents provided their PGY-level and simulator performance data; 38% were senior residents and 62% were junior residents. The mean distance from the entry point (9.4 mm vs 12.6 mm, P = .01), the distance from the target (12.0 mm vs 15.2 mm, P = .16), and final score (31.1 vs 37.7, P = .02) were lower in senior than in junior residents. The mean number of fluoroscopy shots (9.8 vs 10.0, P = .88) was similar in these 2 groups. Linear regression analysis showed that increasing PGY level is significantly associated with a decreased distance from the ideal entry point (P = .001), a shorter distance from target (P = .05), a better final score (P = .007), but not number of fluoroscopy shots (P = .52). CONCLUSION Because technical performance of percutaneous rhizotomy increases with training, we proposed that the skills in performing the procedure in our virtual reality model would also increase with PGY level, if our simulator models the actual procedure. Our results confirm this hypothesis and demonstrate construct validity.
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Affiliation(s)
- Sophia F Shakur
- *Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‡Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois; §ImmersiveTouch, Inc., Westmont, Illinois; ¶Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois; ‖Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
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Application of MRI and intraoperative CT fusion images with integrated neuronavigation in percutaneous radiofrequency trigeminal rhizotomy. Acta Neurochir (Wien) 2015; 157:1443-8; discussion 1448. [PMID: 26066533 DOI: 10.1007/s00701-015-2459-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) has been an effective treatment modality for medically refractory trigeminal neuralgia. Our group has established a protocol for this procedure that includes intraoperative computed tomography (iCT) navigation. The depth of the puncture needle in our protocol was based on cadaveric studies, and anatomical localization was mainly by electric stimulation test. The limitation of the invisibility of the trigeminal cistern on CT imaging and bias from the patient's subjective expression during neurophysiologic stimulation might affect the accuracy of the needle tip and the treatment effect.This study aimed to evaluate the feasibility and preliminary results of the application of magnetic resonance imaging (MRI) and iCT fusion imaging in RF-TR. METHOD The study included 13 patients who received RF-TR with iCT navigation and with recurrence within 3 years. Repeated RF-TR was performed with real-time guidance by MRI and iCT fusion imaging. RESULTS A pain-free or partial satisfactory response was reported with 12 patients (92 %). There was a statistically significant difference in the depth of the needle tip before and after application of MRI and iCT fusion imaging. CONCLUSIONS This preliminary study demonstrated that the application of MRI and iCT fusion could help with anatomical localization of the trigeminal cistern intraoperatively. The improvement in neuronavigation provides a choice in the treatment of recurrent or persistent trigeminal neuralgia after previous intervention. Long-term follow-up of the result is necessary to evaluate the benefit in terms of durability of therapeutic efficacy.
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Easwer HVI, Chatterjee N, Thomas A, Santhosh K, Raman KT, Sridhar R. Usefulness of flat detector CT (FD-CT) with biplane fluoroscopy for complication avoidance during radiofrequency thermal rhizotomy for trigeminal neuralgia. J Neurointerv Surg 2015; 8:830-3. [PMID: 26186933 DOI: 10.1136/neurintsurg-2015-011738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Trigeminal neuralgia (TN) is characterized by episodes of shooting pain in the areas innervated by one or more divisions of the trigeminal nerve. The initial treatment of TN is with drugs but the increased frequency and intensity of the neuralgic episodes often force the patient to seek alternative therapies. Microvascular decompression (MVD) and radiofrequency thermal lesioning of trigeminal rootlets (RFTR) offer close to the best results for TN. MVD has the disadvantage of being an open surgical procedure with its attendant risks and longer hospital stay, whereas RFTR is a short, 'day-care' procedure. However this latter procedure involves positioning of the RF needle in the area behind the trigeminal ganglion through the foramen ovale, which can pose significant challenges. OBJECTIVE To use the fluoroscopic support of a biplane catheter laboratory to access the foramen, and flat detector CT to confirm the location of the tip of the RF needle in the optimal position. METHODS Fifty-three patients with TN underwent RFTR under local anesthesia with conscious sedation. RESULTS All patients reported pain relief with hypesthesia over the offending trigeminal division. In seven patients the needle tip required repositioning according to the CT images. Two patients each had loss of corneal reflex and abducens nerve palsy after the procedure. No other complications were seen. CONCLUSIONS The superior view in two planes coupled with the anatomical confirmation of the position of the needle tip in the Meckel's cave during the rhizotomy reduces the need for multiple passages of the needle to access the foramen ovale and achieves accurate needle tip positioning. The technique increases the safety and precision of such treatments and helps to manage potential complications.
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Affiliation(s)
- Hariharan Venkat Iyer Easwer
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Nilay Chatterjee
- Department of Anesthesia and ICU, Khoula Hospital, Muscat, Sultanate of Oman
| | - Ajith Thomas
- Division of Neurosurgery, Section of Cerebrovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kannath Santhosh
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Kapilamoorthy Tirur Raman
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rupa Sridhar
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Brain abscess after percutaneous therapy for trigeminal neuralgia. Case Rep Infect Dis 2015; 2015:162793. [PMID: 25821610 PMCID: PMC4363676 DOI: 10.1155/2015/162793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 02/11/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of brain abscess following the percutaneous treatment for trigeminal neuralgia. This procedure envisages the access with a needle into the middle cranial fossa through the oral cavity. Thus, in this case, the bacterial infection can be more likely ascribed to the possible contamination of the needle inside the oral cavity rather than to other frequent and more controllable causes of infection like an imperfect sterilization of surgical instruments or an inadequate antiseptic preparation of both operator's hands and patient's skin. The subsequent brain abscess was treated with antibiotic therapy (Vancomycin 2 gr a day and Meropenem 8 g a day for 22 days before the surgical procedure and 30 days after, until complete normalization of laboratory parameters, clinical parameters, and neurological symptoms) and surgical drainage, although the culture of the abscess capsule and the purulent material resulted sterile. In conclusion, the percutaneous therapy for trigeminal neuralgia can be objectively related to risks, even if performed by expert hands. Therefore, it is important that the patient should be advised regarding risks/benefits and/or septic complications of such procedures, even if they occur very seldom. An association of surgery and antibiotic therapy results as effective treatment for this pathologic condition.
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Aydoseli A, Akcakaya MO, Aras Y, Sabanci PA, Unal TC, Sencer A, Hepgul K, Unal OF, Barlas O, Izgi N. Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia: The technique and short-term clinical results. Br J Neurosurg 2015; 29:552-8. [PMID: 25807330 DOI: 10.3109/02688697.2015.1019418] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia. However, this technique has a steep learning curve and significant complications were reported that were related to foramen ovale puncturing. The aim of this study was to evaluate the clinical results of a small patient group who underwent neuronavigation-assisted PBC. METHODS An intraoperative computed tomography (CT) device (CereTom, Neurologica, Danvers, MA/USA) was used to obtain CT scans with 2-mm slice thicknesses. The data were transferred to a neuronavigation system planning station (BrainLab, Feldkirchen, Germany). A soft touch registration system was used for image registration. With the image guidance, a trajectory was defined and the foramen ovale was cannulated using neuronavigation and Hartel's landmarks. RESULTS Sixteen procedures were performed on 13 patients (4 female and 9 male) without complications. The total length of the procedure was not more than 57 min in all instances. CONCLUSIONS We believe that image-guided neuronavigation is useful for neurosurgeons who are at the beginning of their PBC learning curve. It may also be an alternative for particular patients with significant anatomic variations that result in an unsuccessful foramen ovale puncture.
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Affiliation(s)
- Aydin Aydoseli
- a Department of Neurosurgery , Istanbul School of Medicine, Istanbul University , Istanbul , Turkey
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Morphologic Study of Foramen Oval Region on Surgery Approach for Trigeminal Neuralgia. J Craniofac Surg 2015; 26:541-3. [DOI: 10.1097/scs.0000000000001217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Peris-Celda M, Graziano F, Russo V, Mericle RA, Ulm AJ. Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications. J Neurosurg 2013; 119:1176-93. [DOI: 10.3171/2013.1.jns12743] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Foramen ovale (FO) puncture allows for trigeminal neuralgia treatment, FO electrode placement, and selected biopsy studies. The goals of this study were to demonstrate the anatomical basis of complications related to FO puncture, and provide anatomical landmarks for improvement of safety, selective lesioning of the trigeminal nerve (TN), and optimal placement of electrodes.
Methods
Both sides of 50 dry skulls were studied to obtain the distances from the FO to relevant cranial base references. A total of 36 sides from 18 formalin-fixed specimens were dissected for Meckel cave and TN measurements. The best radiographic projection for FO visualization was assessed in 40 skulls, and the optimal trajectory angles, insertion depths, and topographies of the lesions were evaluated in 17 specimens. In addition, the differences in postoperative pain relief after the radiofrequency procedure among different branches of the TN were statistically assessed in 49 patients to determine if there was any TN branch less efficiently targeted.
Results
Most severe complications during FO puncture are related to incorrect needle placement intracranially or extracranially. The needle should be inserted 25 mm lateral to the oral commissure, forming an approximately 45° angle with the hard palate in the lateral radiographic view, directed 20° medially in the anteroposterior view. Once the needle reaches the FO, it can be advanced by 20 mm, on average, up to the petrous ridge. If the needle/radiofrequency electrode tip remains more than 18 mm away from the midline, injury to the cavernous carotid artery is minimized. Anatomically there is less potential for complications when the needle/radiofrequency electrode is advanced no more than 2 mm away from the clival line in the lateral view, when the needle pierces the medial part of the FO toward the medial part of the trigeminal impression in the petrous ridge, and no more than 4 mm in the lateral part. The 40°/45° inferior transfacial–20° oblique radiographic projection visualized 96.2% of the FOs in dry skulls, and the remainder were not visualized in any other projection of the radiograph. Patients with V1 involvement experienced postoperative pain more frequently than did patients with V2 or V3 involvement. Anatomical targeting of V1 in specimens was more efficiently achieved by inserting the needle in the medial third of the FO; for V2 targeting, in the middle of the FO; and for V3 targeting, in the lateral third of the FO.
Conclusions
Knowledge of the extracranial and intracranial anatomical relationships of the FO is essential to understanding and avoiding complications during FO puncture. These data suggest that better radiographic visualization of the FO can improve lesioning accuracy depending on the part of the FO to be punctured. The angles and safety distances obtained may help the neurosurgeon minimize complications during FO puncture and TN lesioning.
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Affiliation(s)
- Maria Peris-Celda
- 1Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- 2Department of Neurosurgery, La Fe University Hospital, Valencia, Spain; and
| | - Francesca Graziano
- 1Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vittorio Russo
- 1Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robert A. Mericle
- 3Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arthur J. Ulm
- 1Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Xiaochuan H, Xiaoyun S, Junsheng L, Ning G, Wenshi G, Zhenxing Z. Percutaneous microballoon compression for trigeminal neuralgia using Dyna-CT. Interv Neuroradiol 2013; 19:359-64. [PMID: 24070086 DOI: 10.1177/159101991301900314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/14/2013] [Indexed: 11/15/2022] Open
Abstract
Percutaneous microballoon compression (PMC) is a well-established technique for treatment of trigeminal neuralgia (TN). However, direct puncture of the foramen ovale (FO) is sometimes difficult and there have been well-reported complications from cannulating the FO. We describe our experiences in using Dyna-CT for cannulating the FO and determining balloon position and volume. Dyna-CT was used to perform image reconstruction in 21 cases. The optimal working projection was generated and further fluoroscopic data were used to determine the needle's relationship to the foramen during puncture. Furthermore, the balloon position and three-dimensional shape were verified by Dyna-CT during balloon compression. The balloon volume and puncture angle were further calculated. Patients' prognosis was further discussed. Dyna-CT allowed quick, safe, and easy cannulation of the FO. It provided three-dimensional images which were more elaborate than the classic 'pear-shaped' images for determining correct positioning in 21 cases. The volume of the flattened balloon ranged from 568.2 mm(3) to 891.4 mm(3) with an average of 775.9 mm(3). The angle of introducing the cannula ranged from 15.17°-35.48° rotation to the midline with an average of 26.24° and 38.47°-51.89° angulation to the Reid line with an average of 46.09°. All the patients were pain free after PMC. Four patients had resolvable masseter weakness and fine touch loss. There was no recurrence of TN during follow-up. Dyna-CT demonstrated three advantages in assisting PMC. Firstly, the FO can be better visualized irrespective of the patient's position. Secondly, needle correction or insertion can be performed much more easily because of the direct fluoroscopic control. Thirdly, the needle position, balloon position, balloon configuration and the volume of the inflated balloon are more reliably determined. The use of dyna-CT provided an assisted method to PMC with a low incidence of complications and good prognosis.
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Affiliation(s)
- Huo Xiaochuan
- The First Affiliated Hospital of Liaoning Medical University; Jinzhou, Liaoning, China - E-mail:
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Huo X, Sun X, Zhang Z, Guo W, Guan N, Luo J. Dyna-CT-assisted percutaneous microballoon compression for trigeminal neuralgia. J Neurointerv Surg 2013; 6:521-6. [DOI: 10.1136/neurintsurg-2013-010676] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nakajima K, Koizuka S, Saito S. New method of percutaneous radiofrequency mandibular nerve rhizotomy guided by high-speed real-time computed tomography fluoroscopy with direct approaching view to foramen ovale. Br J Anaesth 2013; 111:299-300. [PMID: 23858075 DOI: 10.1093/bja/aet237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Measurement accuracy of foramen of vesalius for safe percutaneous techniques using computer-assisted three-dimensional landmarks. Surg Radiol Anat 2013; 36:147-54. [DOI: 10.1007/s00276-013-1148-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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Choi AY, Chung SA, Yun IS. A Case of Abducens Nerve Palsy after Percutaneous Nerve Block for Trigeminal Neuralgia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.3.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ah Young Choi
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Ah Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Il Suk Yun
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Chaisuksunt V, Kwathai L, Namonta K, Rungruang T, Apinhasmit W, Chompoopong S. Occurrence of the foramen of Vesalius and its morphometry relevant to clinical consideration. ScientificWorldJournal 2012; 2012:817454. [PMID: 22629207 PMCID: PMC3353710 DOI: 10.1100/2012/817454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 12/01/2011] [Indexed: 11/29/2022] Open
Abstract
All 377 dry skulls were examined for the occurrence and morphometry of the foramen of Vesalius (FV) both in the middle cranial fossa and at the extracranial view of the skull base. There were 25.9% and 10.9% of FV found at the extracranial view of the skull base and in the middle cranial fossa, respectively. Total patent FV were 16.1% (11.9% unilaterally and 4.2% bilaterally). Most FV were found in male and on the left side. Comparatively, FV at the extracranial view of the skull base had a larger maximum diameter. The distance between FV and the foramen ovale (FO) was as short as 2.05 ± 1.09 mm measured at the extracranial view of the skull base. In conclusion, although the existence of FV is inconstant, its occurrence could not be negligible. The proximity of FV to FO should remind neurosurgeons to be cautious when performing the surgical approach through FO.
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Affiliation(s)
- Vipavadee Chaisuksunt
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Percutaneous Balloon Rhizotomy for Trigeminal Neuralgia Using Three-Dimensional Fluoroscopy. World Neurosurg 2012; 77:202.e1-3. [DOI: 10.1016/j.wneu.2011.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/16/2011] [Accepted: 03/29/2011] [Indexed: 11/18/2022]
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Lin MHC, Lee MH, Wang TC, Cheng YK, Su CH, Chang CM, Yang JT. Foramen ovale cannulation guided by intra-operative computed tomography with integrated neuronavigation for the treatment of trigeminal neuralgia. Acta Neurochir (Wien) 2011; 153:1593-9. [PMID: 21503836 DOI: 10.1007/s00701-011-1009-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/29/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiofrequency rhizotomy of the Gasserian ganglion for the treatment of trigeminal neuralgia via percutaneous cannulation of the foramen ovale is facilitated by various localization modalities. In our preliminary study, we described the feasibility of computed tomography (CT) using an integrated neuronavigation system to cannulate the foramen ovale. METHODS Analysis was performed on 42 consecutive patients who underwent cannulation of the foramen ovale for radiofrequency trigeminal rhizotomy guided by CT using an integrated neuronavigation system. The reproducibility and safety of the neuronavigation-guided procedure were evaluated. RESULTS Overall, the average dimension of the foramen ovale was 7.1 (1.5) × 4.7 (1.1) mm, and it was successfully cannulated by neuronavigation guidance in 31 (73.8%) patients with a mean cannulation time of 3.1 (0.7) min and an overall procedure time of 68.2 (16.4) min. The remaining 11 (26.2%) patients required subsequent CT guidance for successful puncture of the foramen ovale. CONCLUSIONS These data demonstrate that neuronavigation-guided cannulation of the foramen ovale can be executed both quickly and safely on an outpatient basis. Additionally, the use of CT with integrated neuronavigation technology provides superior visual-spatial information compared to conventional fluoroscopy, the process of CT scanning, object planning, and neuronavigation-guided intervention can be completed in the same locale, and its application is easy to master and has the potential to enhance procedure tolerability of awake patients.
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Affiliation(s)
- Martin Hsiu-Chu Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital, 6 Sec West, Chia Pu Rd, Pu Tz City, Chia-Yi, Taiwan
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Tubbs RS, Dixon J, Loukas M, Cohen-Gadol AA. 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. J Neurosurg 2010; 113:493-7. [PMID: 20302392 DOI: 10.3171/2010.3.jns091454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
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Shinohara AL, de Souza Melo CG, Silveira EMV, Lauris JRP, Andreo JC, de Castro Rodrigues A. Incidence, morphology and morphometry of the foramen of Vesalius: complementary study for a safer planning and execution of the trigeminal rhizotomy technique. Surg Radiol Anat 2009; 32:159-64. [PMID: 19760356 DOI: 10.1007/s00276-009-0562-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 09/10/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND The foramen of Vesalius (FV) is located in the greater wing of the sphenoid bone between the foramen ovale (FO) and the foramen rotundum in an intracranial view. The FO allows the passage of the mandibular branch of trigeminal nerve, which is the target of the trigeminal radiofrequency rhizotomy. OBJECTIVE We analyzed its location, morphology, morphometry and interrelation among other foramina. MATERIALS AND METHODS 400 macerated adult human skulls were examined. A digital microscope (Dino-Lite plus) was used to capture images from the FV. A digital caliper was used to perform the measurements of the distance between the FV and other foramina (FO, foramen spinosum and the carotid canal) in an extracranial view of the skull base. RESULTS In the 400 analyzed skulls, the FV was identified in 135 skulls (33.75%) and absent on both sides in 265 skulls (66.25%). The FV was observed present bilaterally in 15.5% of the skulls. The incidence of unilateral foramen was 18.25% of the skulls of which 7.75% on right side and 10.5% on left side. The diameter of the FV was measured and we found an average value of 0.65 mm, on right side 0.63 mm and on the left side 0.67 mm. We verified that positive correlations were statistically significant among the three analyzed distances. CONCLUSIONS This study intends to offer specific anatomical data with morphological patterns (macroscopic and mesoscopic) to increase the understanding of the FV features as frequency, incidence and important distances among adjacent foramina.
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Affiliation(s)
- André Luis Shinohara
- Department of Biological Sciences, FOB/USP, Av. Octávio Pinheiro Brisolla, 9-75, Aeroporto, Bauru, São Paulo, 17012-901, Brazil
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Meng FG, Wu CY, Liu YG, Liu L. Virtual reality imaging technique in percutaneous radiofrequency rhizotomy for intractable trigeminal neuralgia. J Clin Neurosci 2009; 16:449-51. [DOI: 10.1016/j.jocn.2008.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 03/06/2008] [Accepted: 03/12/2008] [Indexed: 10/21/2022]
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Spatial relationships between lingual nerve and mandibular ramus: original study method, clinical and educational applications. Surg Radiol Anat 2009; 31:447-52. [DOI: 10.1007/s00276-009-0466-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
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Tatli M, Sindou M. Anatomoradiological Landmarks for Accuracy of Radiofrequency Thermorhizotomy in the Treatment of Trigeminal Neuralgia. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000313569.43073.b2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR.
Methods:
Of 1000 patients who underwent RF-TR, 100 were retrospective and randomly selected and divided into study groups according to postoperative hypoesthesia in the trigeminal nerve divisions. The patients’ petroclival angle, petroelectrodal angle, electrode tip, and the petroelectrodal angle/petroclival angle ratio were calculated on lateral cranial x-rays. These measurements were then correlated with the topography of hypoesthesia obtained by the RF-TR to define the anatomoradiological x-ray landmarks corresponding to the divisions of the trigeminal root. The postoperative hypoesthesia groups were correlated with their respective preoperative pain topography to check the accuracy of the thermolesion. In addition, the intraoperatively evoked paresthesia responses and the side effects were evaluated. The results were analyzed using a paired-samples Student's ttest, the χ2 test, and one-way analysis of variance, followed by Bonferroni and Tamhane post hoc tests.
Results:
All study groups were comparable with respect to age, sex, side effects, electrode tip location, side of TN, and values of petroclival angle. The lowest values of petroelectrodal angle/orbitomeatal electrodal angle and petroelectrodal angle/ petroclival angle were detected in patients with V3 TN, whereas the greatest values were in patients who had TN in all branches of the trigeminal nerve. The greatest height of the electrode was in patients who had TN in all branches, whereas the least height was in patients with V3TN. When the results were compared with each other, the mean differences were found to be statistically significant between V3 TN patients and the other groups with different Pvalues. There was no statistical difference between the postoperative hypoesthesia data and the preoperative pain topography, which demonstrated evidence of the accuracy of the thermolesion in our series.
Conclusion:
Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.
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Affiliation(s)
- Mehmet Tatli
- Department of Stereotactic and Functional Neurosurgery, Hôpital Neurologique Pierre Wertheimer, University of Lyon, Lyon, France
| | - Marc Sindou
- Department of Stereotactic and Functional Neurosurgery, Hôpital Neurologique Pierre Wertheimer, University of Lyon, Lyon, France
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