Open AccessA Novel Method of Locating Foramen Ovale for Percutaneous Approaches to the Trigeminal Ganglion
Author(s) -
Sung Hyun Lee,
Kang Sup Kim,
Seong Chul Lee,
So Yeon Lee,
Pyoung On Kim,
Misuk Lee,
Kyung Nam Ryu
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.e345
Subject(s) - medicine , percutaneous , foramen ovale (heart) , occipital nerve stimulation , radiology , trigeminal neuralgia , foramen , fluoroscopy , trigeminal nerve , trigeminal ganglion , orthodontics , surgery , patent foramen ovale , psychology , alternative medicine , pathology , sensory system , cognitive psychology
Background: For patients with trigeminal neuralgia who do not respond to medication andfor whom surgical approaches are too risky, percutaneous procedures targeting the trigeminalganglion are the current standard treatment. Percutaneous procedures are performed viathe transoval approach under radiologic guidance. Identification of the foramen ovale (FO)under fluoroscopic guidance is an important part of determining the success or failure of theprocedures.Objectives: Previous studies have described how to visualize the FO under fluoroscopicguidance, but those methods are limited by poor reproducibility. In this study, we haveinvestigated how to visualize the FO clearly and easily under fluoroscopic guidance.Study Design: Retrospective analysis.Setting: University hospital in Korea.Methods: Seventy-two 3-dimensional facial computed tomography scans without anatomicabnormalities of the skull base were analyzed for verifying the novel method. First, themandibular angle and the occipital cortical line were overlapped and then turned by 15° obliquerotation using the software package. After these manipulations, the visualization of the FOwas graded according to a 4-point scale (0: poor; 1: fair; 2: good; 3: excellent), and the inferiortransfacial and oblique angles were measured.Results: This enabled clear visualization of the FO. The mean visual grade of 54 right and 46left FO (total 100) was 2.74 (0: poor; 1: fair; 2: good; 3: excellent). All recorded FOs had at leastgrade 2 visibility.Limitations: This study is lacking application in clinical practice and comparative data to thesubmental view.Conclusions: The mandible angle and the occipital cortex line are obvious anatomic landmarksand are visible even to nonexperienced practitioners. Therefore, our method using theseanatomic landmarks can improve the reproducibility and accuracy of FO visualization.Key words: Trigeminal neuralgia, foramen ovale, trigeminal ganglion, 3-dimensional (3D)facial computed tomography (CT) scans