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Objective Based on CT imaging measurements to investigate the relevant parameters of 3D positioning that are used for the puncturing of trigeminal nerve via foramen rotundum route, and to discuss the influences of gender, age, and BMI on the measurements of these parameters in order to improve the success rate of puncturing. Methods A total of 64 patients with trigeminal neuralgia (second branch), who were successfully treated with CT - guided radiofrequency thermocoagulation of trigeminal nerve via foramen rotundum route during the period from August 2015 to March 2017, were included in this study. Their CT images were retrospectively analyzed. The line from the opening of the external auditory canal to the root of the nose (ear-nose line) was used as the base line on sagittal plane, and the angle between the ear-nose line and the puncture needle (angle α) was measured. On transverse section drawing a line between the midpoint of nose bridge and the midpoint of the posterior edge of the ethmoid sinus (M line), the angle between M line and the puncture needle (angle β) was determined. The vertical distance from the midpoint of the foramen rotundum to M line(D1), the vertical distance from needle puncture point to M line(D2), and the puncture depth (D3) were respectively measured. Results The angle α varied from 44. 10° to 63. 50° with a mean of (55. 05°±5. 48°). The angle β ranged from 26. 42° to 68. 37° with an average of (38. 19°±8. 58°). The distance of D1 was (19. 55±2. 67) mm, the distance of D2 was (58. 50±5. 41) mm, and the depth of D3 was (64. 89+8. 21) mm. The gender, age and BMI value showed a close correlation with the puncture angle and the puncture depth (P＜0. 05), and no statistically significant differences in these indexes existed between the left side and the right side (P＞0. 05). Conclusion The angle a and the other puncture parameters can roughly determine the three dimensional spatial orientation of foramen rotundum, which can be further adjusted according to patient's gender, age and BMI value. (J Intervent Radiol, 2018, 27: 234-237)
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Objective To explore the effectiveness and precision of 3D printing navigational template in puncturing of foramen rotundum for radiofrequency thermocoagulation to treat primary trigeminal neuralgia (V2).Methods Forty-three patients (27 males,16 females,aged 45-85 years,ASA grade Ⅰ or Ⅱ) with primary trigeminal neuralgia (V2) were included and randomly divided into experimental group (group A,n=21) and control group (group B,n=22).After taking a CT scan and 3D reconstruction of each patient's skull,puncture simulations were carried out,then the final puncture schemes were decided.In group A,puncture was performed under guidance of navigational template but was conducted empirically in group B.In both groups,3D-CT image and electrical stimulation were used in all the procedures to confirm the location of point of needle before radiofrequency thermocoagulation.The cases of successful puncture in one-time,times of CT scanning,radiant quantity,operation time during the operation in both groups were recorded.Furthermore,NRS scores and complications including hypoesthesia,motor function degeneration,hematoma,absence of corneal reflex,cerebrospinal fluid leakage were recorded after procedure.Results The rate of successful puncture in one-time of group A was superior than that of group B (90.4% vs.22.7%).Compared with group B,CT scan times [(1.1±0.3) times vs.(2.8±1.3) times],radiant quantity [(323.1±108.7) mGy*cm vs.(787.8±355.7) mGy*cm],operation time [(15.3±5.5) min vs.(28.5±6.5) min] in group A were significantly reduced (P<0.05).NRS scores of both two groups were obviously reduced after surgery [group A: (3.1±1.7) scores vs.(8.5±0.7) scores;group B: (3.1±1.5)scores vs.(8.5±0.7) scores] (P<0.05),but the effectiveness in group A was not superior than group B.No serious complications occurred in all patients.Conclusion On the basis of sufficient preoperative planning of puncture approach,3D printing template can significantly enhance the effectiveness and precision of puncture of foramen rotundum,improving the efficiency and quality of radiofrequency treatment of primary trigeminal neuralgia (V2).
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Objective:To measure the safe range from the foramen rotundum to the siphon of internal carotid artery using three-dimensional reconstruction technique, and to provide guidance for operation through pterygopalatine fossa.Methods:The skulls of 121 volunteers were scanned to get the final results with thin-section computed tomographic images.The position of the siphon of internal carotid artery (point A)and foramen rotundum (pointB)were ascertained.Three-dimensional reconstruction technique was used to build a coordinate system paralleled to the frankfort horizontal plane and the nasal septum plane.The coordinate system took point A as the coordinate origin.Point C and point D were the projections of point A in two planes parallel with frankfort horizontal plane and nasal septum plane which included point B.The distances of AC,AB,and BC were measured. The angles of the line went through A and B to the three planes were also measured.Results:The distance of AC was measured as 13.22 (3.79)mm (range,8.33 - 105.67 mm;95%CI:8.55 - 21.39 mm).The angle to the sagittal plane was measured as 33.54 (9.23)° (range,5.38- 66.58°;95%CI:30.88 - 34.20°). The angle to the coronal plane was measured as 53.17 (10.48)°(range,5.60-75.02°;95%CI:51.29-55.06°).The angle to the horizontal plane was measured as 9.43 (12.91 ) mm (range,- 28.44 - 82.22;95% CI:7.11 - 11.76 ). Conclusion:The safety distance from foramen rotundum to the siphon of internal carotid artery in the operation through pterygopalatine fossa (PPF) under nasoendoscope is obtained by thin-section computed tomographic images.
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Three foramina can be identified in the greater wing of the sphenoid bone: The foramen rotundum (FR), foramen ovale (FO) and foramen spinosum (FS). In addition, there may be another foramen called foramen ovale accessorium or foramen vesalius (FV) which connects the middle cranial fossa to the fossa pterygoidea (pterygoid fossa). It is described as an opening with smooth walls in front and medial to foramen ovale which leads to an oblique channel directed towards the fossa pterygoidea. FV was present between FO and FR in 14 (31.8%) of 44 dry and 6 (33.3%) of 18 cadaver skullbase sides (total 20 (32.3%) of 62). The diameter values of foramens on both the right and the left side were observed to be almost symmetrical. FR's distance from the midline on the left side was greater than the right side. Also, the distance between FO and the petrous apex and the distance between FS and the petrous apex were greater on the left side. On the right side the distance between FO and FR, and the distance between FO and FS were greater. Also, the distance between FR and the petrous apex was greater on the right side. Anatomical variations in appearance size and distance of FR, FO, FS and FV are of great surgical importance. In conclusion, we can infer that the information provided with this study can help the neurosurgeon and anatomist to increase the knowledge about anatomy of middle cranial fossa.
Tres forámenes pueden ser identificados en el ala mayor del esfenoides: El foramen redondo (FR), foramen oval (FO) y el foramen espinoso (FS). Puede además existir otro foramen llamado foramen oval accesorio o foramen de Vesalio (FV), que conecta la fosa craneal media a la fosa pterigoidea. Se describe como una abertura con paredes lisas por anterior y medial al foramen oval, que conduce a un canal oblicuo dirigido hacia la fosa pterigoidea. FV estuvo presente entre FO y FR en 14 (31,8%) de 44 cráneos secos y 6 (33,3%), en 18 lados en la base de cráneos de cadáveres (total 20 (32,3%) de 62). El diámetro de los forámenes en los lados derecho e izquierdo se observó casi simétricos. Las distancias de FR desde la línea mediana en el lado izquierdo fue mayor que en el lado derecho. Además, la distancia entre FO y el vértice de la porción petrosa y la distancia entre el FS y el vértice porción petrosa fueron mayores en el lado izquierdo. En el lado derecho la distancia entre A y FR, así como la distancia entre A y FS fueron mayores. Por otra parte, la distancia entre los FR y el vértice del porción petrosa fue mayor en el lado derecho. Las variaciones anatómicas en el tamaño de la apariencia y la distancia de FR, DE, FS y FV son de gran importancia quirúrgica. Podemos inferir que la información proporcionada en este estudio puede ayudar al neurocirujano y anatomista para aumentar el conocimiento sobre la anatomía de la fosa craneal media.
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Humans , Adult , Sphenoid Bone/anatomy & histology , Cranial Fossa, Middle/anatomy & histology , CadaverABSTRACT
Objective To investigate the three-dimensional spatial relationships of the sphenopalatine foramen ( SPF) , vidian canal ( VC ) , and foramen rotundum ( FR ) with regard to an endoscopic endonasal approach to the pterygopalatine fossa(PPF)using three-dimensional reconstruction of high resolution computed tomography (HRCT) scans. Methods The HRCT scans of 17 patients and a cadaver specimen were retrospectively evaluated .The morphology of the SPF, VC, and FR as well as the spatial relationship between the SPF and VC were measured on the image of three -dimensional CT reconstruction.Results The mean diameters of the SPF, VC, and FR were(6.26 ±1.59)mm,(2.35 ± 0.77)mm and(2.75 ±0.77)mm, respectively.The mean distance between the VC and posteroinferior margin of SPF was (4.03 ±1.15) mm.The mean vertical and horizontal distances on the image of three-dimensional CT reconstruction were between the VC and FR were(4.94 ±1.35)mm and(9.22 ±3.07)mm, respectively.The whole or partial margin of the VC was above the inferior margin of the SPF in 92%(33/36) of the VC and lateral to the posterior margin of the SPF in 97%(35/36) of the VC.Conclusion The endoscopic endonasal approach to the PPF is performed with greater safety through comprehension of the spatial relationships between the SPF , VC, and FR.