Iwanaga Joe, Badaloni Filippo, Laws Tyler, Oskouian Rod J, Tubbs R Shane
Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Neurosurgery Department, Santa Corona Hospital, Pietra Ligure, SV, Italy.
World Neurosurg. 2018 Feb;110:e245-e248. doi: 10.1016/j.wneu.2017.10.140. Epub 2017 Nov 22.
The aim of this study was to describe the anatomic trajectory of the extracranial needle for percutaneous rhizotomy and correlate this with structures at risk during such a procedure.
Six sides from 3 frozen fresh Caucasian heads were used in this study. Hartel anatomic landmarks for percutaneous trigeminal rhizotomy procedures were used. A free hand technique was then used, and intraprocedural visualization of the needle was performed with fluoroscopy. When the procedure was completed, the face was dissected along with the needle pathway up to the foramen ovale in order to evaluate for any damaged structures.
On all sides, the needle passed lateral to the buccinator muscle and near the parotid duct to then pierce the superior head of the lateral pterygoid muscle to enter the infratemporal fossa. This placed the needle near the buccal nerve on all sides, although no direct injury was noted. Although very near, no branches of the facial nerve or artery were damaged. On 1 side, the maxillary artery was pierced.
To our knowledge, this is the first study to describe the detailed extracranial anatomic needle pathway using the Hartel approach. Such data might help surgeons better recognize potential complications from such procedures.
本研究旨在描述经皮神经根切断术颅外针的解剖轨迹，并将其与该手术过程中存在风险的结构相关联。
本研究使用了来自3个冷冻新鲜高加索人头的6个侧面。采用经皮三叉神经神经根切断术的哈特尔解剖标志。然后采用徒手技术，并通过荧光透视对针在手术过程中的可视化情况进行观察。手术完成后，沿针道连同面部一起解剖至卵圆孔，以评估是否有任何结构受损。
在所有侧面，针均从颊肌外侧穿过并靠近腮腺导管，然后穿入翼外肌上头进入颞下窝。这使得针在所有侧面都靠近颊神经，尽管未发现直接损伤。虽然非常接近，但面神经或动脉的分支均未受损。在1个侧面，上颌动脉被刺穿。
据我们所知，这是第一项使用哈特尔方法描述详细颅外解剖针道的研究。这些数据可能有助于外科医生更好地识别此类手术的潜在并发症。
