Effect of modified Hartel approach for foramen ovale cannulation / 临床麻醉学杂志

ABSTRACT

Objective Based oncomputer-aided design (CAD) technology, we compared the optimized method of locating inserting point (2 cm lateral to and 1 cm below angulus oris) with traditional ones and assessed its clinical value by simulating foramen ovale (FO) cannulation. Methods Skull CT data of 100 primary trigeminal neuralgia patients were used in this study and three-dimensional reconstruction with FO cannulation simulation were conducted. With self-control test method, each patient was divided into three groups group of optimized insertion point (method O) point 2 cm lateral to and 1 cm below angulus oris as the insertion point; group of traditional entry point A (method A) 2.5 cm lateral the angulus oris as the insertion point; group of traditional entry point B (method B) intersecting the external extension of angulus oris and the vertical line of the lateral eye angle as the entry point. Puncture simulation was performed along connecting line of insertion point and the central point of the FO. We recorded results of simulation and measured the available area and short diameter of FO in the direction of puncture. Results The cases that the puncture route was obstructed of methods O, A and B were 15, 28 and 31, respectively. The occlusion rate of method O was significantly lower than those of methods A and B (P ＜ 0.01 or P ＜ 0.05). The available area of methods O, A and of B were (9.45 ± 6.57) mm2, (6.91 ± 5.96) mm2, (6.59 ± 5.86) mm2, respectively. The available area of method O was significantly larger than those of methods A and B (P ＜ 0.01 or P ＜ 0.05). The short diameters of methods O, A and B were (2.25 ± 1.04) mm, (1.81 ± 0.97) mm, (1.71 ± 0.92) mm, respectivtly. Short diameters of method O was significantly longer than those of methods A and B (P ＜ 0.01 or P ＜ 0.05). Conclusion compared with the traditional positioning method, the optimized method can provide better condition for puncture through Hartel approach.