Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (5): 95-102.doi: 10.6040/j.issn.1671-7554.0.2024.0193

• Clinical Medicine • Previous Articles    

Establishment and application of three-dimensional computed tomography reconstruction-guided percutaneous lateral approach for foramen ovale puncture

LIANG Yuanhao1, XIAO Wenshan2, PENG Shengxin3, ZHANG Yixiang1, SHI Bin4, YU Gongchang4, LIU Lei5   

  1. 1. College of Traditional Chinese Medicine, Shangdong Second Medical University, Weifang 261053, Shandong, China;
    2. College of Sports Medicine and Rehabilitation, Shandong First Medical University, Taian 271016, Shandong, China;
    3. College of Rehabilitation Medicine, Binzhou Medical University, Binzhou 256603, Shandong, China;
    4. Department of Pain Treatment, Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan 250014, Shandong, China;
    5. Department of Pain Treatment, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China
  • Published:2024-05-29

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Abstract: Objective To investigate three-dimensional computed tomography(CT)-guided percutaneous lateral approach for foramen ovale puncture and introduce a novel method for treating trigeminal neuralgia through selective radiofrequency thermocoagulation. Methods Three adult skull specimens with sawn parietal bones were scanned using a 22 G radiofrequency puncture needle. The Hartel anterior and lateral approaches for puncture were simulated. The needle tips were inserted into the foramen ovale, followed by skull CT scan with the puncture needles in place. The specimens were scanned to establish a standard image for CT perforations. Using the CT reconstruction data, the relationship between the needle positions and tips for the two pathways was measured and analyzed. This analysis helped determine the techniques and skills required for the lateral approach puncture to accurately target the semilunar ganglion. Additionally, the clinical data of 64 patients with primary trigeminal neuralgia types 2 and 3, who were treated with radiofrequency thermocoagulation in the Gasserian ganglion from March 2022 to February 2023, were retrospectively analyzed to assess treatment efficacy and sensory loss. Results Using the needle and skull specimen, complemented by CT scan and image reconstruction, two puncture pathways were compared. The CT-guided percutaneous lateral approach facilitated the successful establishment of a foramen ovale perforation, which was applied to treat 64 patients with primary trigeminal neuralgia, achieving successful entry into the foramen ovale and enabling selective ganglion radiofrequency thermocoagulation. The patients were followed for 1 week to 12 months, with an average of(6.0±1.9)months, and reported treatment satisfaction and no recurrence. Conclusion The application of CT-guided percutaneous lateral perforation technique provides a new and feasible therapeutic approach for treating trigeminal neuralgia by selective radiofrequency thermocoagulation of the semilunar ganglion.

Key words: Trigeminal neuralgia, Radio frequency, 3D-CT reconstruction, Ovarian foramen, Lateral approach, Skull specimens

CLC Number: 

  • R651.1
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