Bi-Plane Fluoroscopic-Guided Balloon Rhizotomy for Trigeminal Neuralgia: A Technical Note. (1st September 2019)

• Record Type: Journal Article
• Authors: Vance, Awais; Ahmadieh, Tarek Youssef El; Christian, Zachary; Aoun, Salah G; Barnett, Samuel L; White, Jonathan A
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_417
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The classic partially blinded percutaneous technique using external landmarks to cannulate the foramen ovale for the treatment of trigeminal neuralgia can place important anatomical structures, such as the distal cervical internal carotid artery, at risk. We have developed a new technique in which we use anteroposterior fluoroscopy to reliably locate the foramen ovale and thus make it safer and easier to cannulate. METHODS: Locating foramen ovale was initially tested using anteroposterior 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 performed in multiple patients with trigeminal neuralgia. This technique was successfully used in multiple patients at our institution without any immediate complications except for one cheek hematoma. 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.