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An alternative projection for fluoroscopic-guided needle insertion in the foramen ovale: technical note
Peter Grunert1, Martin Glaser, Ralf Kockro
1Klinik für Neurochirurgie, Universitaetsmedizin, Johannes Gutenberg Universitaet, Mainz, Germany. grunert@nc.klinik.uni-mainz.de
Acta Neurochirurgica
|June 15, 2010
Summary
A new oblique fluoroscopic technique improves needle placement into the foramen ovale for trigeminal neuralgia treatment. This method enhances visualization and accuracy, simplifying the procedure for patients undergoing ganglion Gasseri interventions.
Area of Science:
- Neurosurgery
- Radiology
- Pain Management
Background:
- Trigeminal neuralgia is often treated by puncturing the Gasserian ganglion via the foramen ovale.
- Standard techniques for needle insertion into the foramen ovale can be challenging.
Purpose of the Study:
- To present an improved biplane fluoroscopic technique for accurate needle insertion into the foramen ovale.
- To evaluate the efficacy and safety of this new technique in cadaveric models and clinical patients.
Main Methods:
- An alternative oblique X-ray trajectory was evaluated on cadaveric skull models.
- The ideal trajectory was then applied to 13 patients with trigeminal neuralgia for intraforaminal needle placement.
Main Results:
- A coaxial oblique projection (mean rotation 20.9°, angulations 28°) was proposed and found ideal for visualizing needle position in cadavers.
- Immediate and accurate needle insertion into the foramen ovale was achieved in all 13 patients.
- No complications were reported during the procedures.
Conclusions:
- The novel oblique projection offers superior visualization of the foramen ovale compared to the standard submental projection.
- This technique facilitates easier needle manipulation and more reliable confirmation of correct needle placement.
- Further research is warranted to confirm the superiority of coaxial projection over standard techniques for needle insertion into the foramen ovale.
