Improved visualization of the foramen ovale for percutaneous approaches to the gasserian ganglion

Technical note

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✓ Percutaneous procedures for treating trigeminal neuralgia involve the penetration of foramen ovale using cutaneous landmarks and radiological guidance. The placement of radiopaque markers over the commonly used “zygomatic points” in front of the ears provides landmarks on intraoperative radiological studies that facilitate localization of the foramen ovale. Speed and safety of percutaneous trigeminal procedures should be enhanced. There is no increase in radiation exposure over that in other commonly used approaches.

Article Information

Address reprint requests to: Arthur M. Gerber, M.D., Section of Neurosurgery, Mercy Hospital, 2238 Jefferson Avenue, Toledo, Ohio 43624.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photograph (left) and x-ray film (right) of a skull showing the metal rings (5 mm in diameter) on the “zygomatic point” used as landmarks when performing percutaneous procedures involving the penetration of the foramen ovale.

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    X-ray studies of an edentulous dried skull without mandible in the left extended oblique position. Left: X-ray film showing the metal rings on the “zygomatic points” (large arrows) and the foramen ovale (small arrow). Right: X-ray film demonstrating the position of foramen ovale with respect to a line connecting the metal rings on the zygomatic points and to the lateral rim of the orbit.

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    X-ray film of a volunteer's head in the left extended oblique position showing the relative positions of the foramen ovale (black arrowhead) and lead markers over the zygomas (white arrowheads). Open arrows delineate the anterior edge of the right mandibular ramus.

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    Intraoperative fluoroscopic image showing the relative positions of lead markers (4 mm in diameter, arrowheads) and the foramen ovale (fo) at the tip of the needle during a balloon compression procedure. Open arrow points to the lateral rim of the orbit. The patient's head is placed in the right extended oblique position.

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