Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy

Gusmão, Sebastião; Oliveira, Marcelo de Lima; Tazinaffo, Uedson; Honey, Christopher R.

doi:10.3171/jns.2003.99.4.0785

Cited by 85 publications

(67 citation statements)

References 10 publications

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“…43,45,46 Complementary to this knowledge, anatomical research provides direct measurements and visualization as tools to improve the accuracy and selectivity of the lesions. The FO visualization rate with radiography and optimal angles of view remain within a wide range as reported in the literature, 9,11,12,14 and are mostly subject to the experience of the neurosurgeon.…”

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confidence: 89%

Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications

Peris-Celda

Graziano

Russo

et al. 2013

JNS

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F oramen ovale puncture was first described by Här-tel in 1914 18 as a percutaneous route to the Meckel cave to treat trigeminal neuralgia. Microvascular decompression induces little or no hypesthesia and is usually the treatment of choice for young patients without comorbidities.3 However, less invasive techniques, including FO puncture, are preferred 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 rad...

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mentioning

confidence: 89%

Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications

Peris-Celda

Graziano

Russo

et al. 2013

JNS

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“…This bony lamina may cause trigeminal neuralgia by compressing mandibular nerve passing in FO [9]. Trigeminal neuralgia is the most common treating by percutaneous trigeminal rhizotomy done through FO [5,10,11]. So this bony lamina make difficulty to accessing foramen ovale for therapeutic approach [12].…”

Section: Discussionmentioning

confidence: 99%

Unilateral Atypic Foramen Ovale in Dried Human Skull: Surgical Importance of a Rare Bone Variation

Şenol¹,

Çay²,

Yilmaz³

et al. 2016

Med-Science

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“…Transcondylar, supracondylar, and other lateral surgical approaches provide access to various foramina on the base of skull and prevent broad retraction of the neural structures passing through them [7].…”

Section: Many Clinical Conditions Have Been Associatedmentioning

confidence: 99%

Morphometry and Surgical Importance of Foramen Magnum

Arora¹,

Sharma²,

Siddiqui³

et al. 2017

IJAR

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Introduction:The Foramen Magnum (FM) lies in an anteromedian position and leads into the posterior cranial fossa. It is oval and wider behind, with its greatest diameter being anteroposterior. It contains the lower end of the medulla oblongata, meninges, vertebral arteries and spinal accessory nerve. The apical ligament of dens and the tectorial membrane pass through it, to attach to the basiocciput. Anteriorly the margin of foramen magnum is slightly overlapped by the occipital condyles. Transcondylar, supracondylar, and other lateral surgical approaches provide access to various foramina on the base of skull and prevent broad retraction of the neural structures passing through them Morphometric analysis of foramen magnum plays important role in transcondylar approach. Aim: The study was designed to measure the diameters and shape of foramen Magnum and correlates the measurements with clinical importance, as its shape and variation in diameters will be of great help to operating surgeon during surgical procedures. Materials and Methods: Forty dry human skulls were studied during this research work. Skulls were taken from the department of anatomy, dayanand medical college and hospital, Ludhiana and other medical college. Results: During this study the mean MAPD was 35.42mm, the MTD found to be 27.90mm The Foramen magnum Index found to be 17.20mm. The shape of foramen magnum found mostly was oval in 60% cases. The anterior inter condylar distance found to be 18.01 to 20.00mm. Whereas middle intercondylar distance is 20.1 to 22mm and posterior was 30.01 to 32.00mm. Conclusion:The present study had observed the variation in the measurements of skull base foramen magnum which were different from observations by the western studies because of difference of race and geographical areas.

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Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy

Cited by 85 publications

References 10 publications

Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications

Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications

Unilateral Atypic Foramen Ovale in Dried Human Skull: Surgical Importance of a Rare Bone Variation

Morphometry and Surgical Importance of Foramen Magnum

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