Comprehensive anatomy of the foramen ovale critical to percutaneous stereotactic radiofrequency rhizotomy: cadaveric study of dry skulls

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  • 1 Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota;
  • 2 Department of Neurosurgery, University of Cincinnati College of Medicine; and
  • 3 Headache and Facial Pain Center, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio

OBJECTIVE

Percutaneous stereotactic radiofrequency rhizotomy (PSR) is often used to treat trigeminal neuralgia, a serious condition that results in lancinating, episodic facial pain. Thorough understanding of the microsurgical anatomy of the foramen ovale (FO) and its surrounding structures is required for efficient, effective, and safe use of this technique. This morphometric study compares anatomical and surgical orientations to identify the variations of the FO and assess cannulation difficulty.

METHODS

Bilateral foramina from 174 adult human dry skulls (348 foramina) were analyzed using anatomical and surgical orientations in photographs from standardized projections. Measurements were obtained for shape, size, adjacent structures, and morphometric variability effect on cannulation. The risk of potential injury to surrounding structures was also assessed.

RESULTS

The authors identified 6 distinctive shapes of the FO and 5 anomalous variants from the anatomical view, and 6 shapes from the surgical view. In measurements of surface area of this foramen obtained using the surgical view, loss (average 18.5% ± 5.7%) was significant compared with the anatomical view. Morphometrically, foramen size varied significantly and obstruction from a calcified pterygoalar ligament occurred in 7.8% of specimens. Importantly, 8% of foramina were difficult to cannulate, thus posing a 12% risk of inadvertent cannulation of the foramen lacerum.

CONCLUSIONS

Significant variability in the FO’s shape and size probably affected its safe and effective cannulation. Preoperative imaging by 3D head CT may be helpful in predicting ease of cannulation and in guiding treatment decisions, such as a percutaneous approach over microvascular decompression or radiosurgery.

ABBREVIATIONS AP = anteroposterior; FO = foramen ovale; ICA = internal carotid artery; LPP = lateral pterygoid plate; PSR = percutaneous stereotactic radiofrequency rhizotomy; TN = trigeminal neuralgia.

Contributor Notes

Correspondence Jeffrey T. Keller: c/o Glia Media, Cincinnati, OH. mary.kemper@gliamedia.com.

INCLUDE WHEN CITING Published online April 19, 2019; DOI: 10.3171/2019.1.JNS18899.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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