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Paweł Daszkiewicz, Piotr Zwoliński and Marcin Roszkowski

procedures performed using the “from below” approach might be promising. Disclaimer The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This article contains some figures that are displayed in color online but in black and white in the print edition. References 1 Bale RJ , Laimer I , Martin A , Schlager A , Mayr C , Rieger M , : Frameless stereotactic cannulation of the foramen ovale for ablative treatment of trigeminal neuralgia . Neurosurgery 59

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Arthur M. Gerber

S ince the description of the anterior approach through the cheek to the foramen ovale by Hartel 2 in 1914, this approach has been used for injection, 3, 6, 7 radiofrequency coagulation, 5, 9, 11 and balloon microcompression 1, 4 of the gasserian ganglion. Numerous approaches have been suggested for the radiographic monitoring of needle position during penetration of the foramen ovale. Perl and Ecker, 7 using x-ray studies, positioned the patient's head so that a vertical line passing through the cheek would penetrate the foramen. The patient's head was

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Tomasz Mandat, Boguslaw Brozyna, Grzegorz Krzymanski and Jan K. Podgorski

S ince the introduction of contemporary techniques for cannulation of the foramen ovale at the beginning of the 20th century, 8 , 15 percutaneous ablative procedures for trigeminal neuralgia have been widely used for large groups of patients, including such methods as alcohol or glycerol injections, 7 , 11 balloon compression, 10 electrocoagulation, 9 and radiofrequency thermocoagulation of the gasserian ganglion. 12 During a transovale approach to the gasserian ganglion, the needle passes through a 3 × 6–mm natural foramen (the foramen ovale) located

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Charles H. Tator and David W. Rowed

T he anterior percutaneous approach 1 is widely employed for injection 3, 4 and thermocoagulation 2, 5, 8 of the Gasserian ganglion. Various radiographic methods 3 have been employed to facilitate location of the foramen ovale, and placement of the tip of the penetrating needle within the trigeminal ganglion or rootlets. Some of these techniques are unnecessarily complex. 3, 4 Moreover, the position of the patient for the submentovertical projection, which has usually been employed, 3, 5 is needlessly uncomfortable. 2 Fluoroscopic methods have been

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Maria Peris-Celda, Francesca Graziano, Vittorio Russo, Robert A. Mericle and Arthur J. Ulm

F oramen ovale puncture was first described by Härtel 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 in older patients and have resulted in significant and persistent pain relief. Foramen ovale puncture is followed by destruction of TN fibers using radiofrequency ablation, microcompression with a Fogarty

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Adel Elnashar, Smruti K. Patel, Almaz Kurbanov, Kseniya Zvereva, Jeffrey T. Keller and Andrew W. Grande

T he foramen ovale (FO) is a well-described anatomical structure located in the greater wing of the sphenoid bone that varies greatly in shape and size. 36 , 49 The anatomy of this region first gained clinical importance in 1914 for treatment of trigeminal neuralgia (TN) with the introduction of the Härtel method, a technique to anesthetize the trigeminal ganglion and nerve by inserting an electrode into these structures through this foramen. 17 , 48 Detailed knowledge of the anatomical structures that pass through or around the FO is critical to the

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Neurosurgical Forum: Letters to the editor To The Editor Rodney E. Frothingham , M.D. Greenville, Mississippi 245 245 In the February, 1976, issue of the Journal (Tator CH, Rowed DW: Fluoroscopy of foramen ovale as an aid to thermocoagulation of the Gasserian ganglion. Technical note. J Neurosurg 44: 254–257, February, 1976), the author describes a fluoroscopic method of guiding the needle into the foramen ovale. Nearly 2 years ago this exact technique was printed in the May, 1974 Journal of the South Carolina

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Sarah K. Bick, Marjan S. Dolatshahi, Benjamin L. Grannan, Andrew J. Cole, Daniel B. Hoch and Emad N. Eskandar

candidacy. Such procedures include subdural grid or strip electrodes, stereotactic depth electrodes, and, for cases in which a mesial temporal focus is suspected, foramen ovale electrodes (FOEs). FOEs are a minimally invasive method of investigating mesial temporal epileptic activity. FOE placement was first described in 1985 as a minimally invasive method to help differentiate mesial temporal from lateral neocortical seizures. 26 Electrodes are percutaneously introduced through the foramen ovale under fluoroscopic guidance. Electrode contacts sit in the ambient cistern

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Matthew J. Zdilla, Brianna K. Ritz and Nicholas S. Nestor

T he foramen ovale (FO) is frequently cannulated. Most commonly, cannulation of the FO is performed for the treatment of trigeminal neuralgia, which may be accomplished through radiofrequency thermocoagulation, glycerol rhizotomy, or balloon compression. 8 , 22 However, the foramen has been approached for myriad other reasons, including for the purpose of tumor biopsy, 5 , 21 , 28 , 30 electroencephalography of the temporal lobe, 35 administration of opiates into the trigeminal cistern for the relief of pain caused by cancer, 9 occlusion of a clival dural

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Mahmoud Messerer, Julie Dubourg, Ghislaine Saint-Pierre, Emmanuel Jouanneau and Marc Sindou

A large variety of lesions may develop in the cavernous sinus region and surrounding area such as tumors (some of them nonsurgical) or pseudotumors of inflammatory origin. Sometimes imaging is not evocative enough to ascertain pathological diagnosis. Percutaneous biopsy through the foramen ovale route may then be performed to aid therapeutic decision-making, thus avoiding unnecessary open surgery when lesions are confirmed to be nonsurgical or nonresectable. In such cases, a biopsy is crucial to allow appropriate medical treatment or chemotherapy and