Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Neurosurgery, Stanford Hospital, Stanford, California, USA.
Oper Neurosurg (Hagerstown). 2023 Apr 1;24(4):341-349. doi: 10.1227/ons.0000000000000590. Epub 2023 Jan 23.
Percutaneous trigeminal rhizotomy (PTR) is a widely used procedure for trigeminal neuralgia. However, comprehensive analyses that combine anatomic, radiological, and surgical considerations are rare.
To present high-quality anatomic dissections and radiological studies that highlight the technical nuances of this procedure.
Six silicon-injected postmortem heads underwent PTR. The surgical corridors were dissected, and the neurovascular relationships were studied. In addition, 20 dried human skulls and 50 computed tomography angiography and MRI scans were collected to study the anatomic relationships for a customized puncture corridor.
The PTR corridor was divided into 3 segments: the buccal segment (length, 34.76 ± 7.20 mm), the inferior temporal fossa segment (length, 42.06 ± 6.92 mm), and the Meckel cave segment (length, 24.75 ± 3.34 mm). The puncture sagittal (α) and axial (β) angles measured in this study were 38.32° ± 4.62° and 19.13° ± 2.82°, respectively. The precondylar reference line coincided with the foramen ovale in 75% of the computed tomography angiography scans, and the postcondylar line coincided with the carotid canal in 70% of the computed tomography angiography scans; these lines serve as the intraoperative landmarks for PTR. The ovale-carotid-pterygoid triangle, delineated by drawing a line from the foramen ovale to the carotid canal and the lateral pterygoid plate, is a distinguished landmark to use for avoiding neurovascular injury during fluoroscopy.
Knowledge of the anatomic and radiological features of PTR is essential for a successful surgery, and a customized technical flow is a safe and effective way to access the foramen ovale.
经皮三叉神经根切断术（PTR）是治疗三叉神经痛的常用方法。然而，综合考虑解剖、放射学和手术因素的全面分析很少见。
呈现高质量的解剖学解剖和放射学研究，突出该手术的技术细节。
6 个头骨经过硅酮注射后进行 PTR。解剖手术通道，并研究神经血管关系。此外，收集了 20 个干人头骨和 50 个 CT 血管造影和 MRI 扫描，以研究用于定制穿刺通道的解剖关系。
PTR 通道分为 3 个节段：颊侧节段（长度为 34.76±7.20mm）、颞下窝节段（长度为 42.06±6.92mm）和 Meckel 腔节段（长度为 24.75±3.34mm）。本研究中测量的穿刺矢状角（α）和轴角（β）分别为 38.32°±4.62°和 19.13°±2.82°。75%的 CT 血管造影扫描中，髁前参考线与卵圆孔重合，70%的 CT 血管造影扫描中，髁后线与颈动脉管重合；这些线作为 PTR 的术中标志。卵圆孔-颈动脉-翼突三角，由从卵圆孔到颈动脉管和翼突板外侧画一条线划定，是在透视下避免神经血管损伤的一个明显标志。
了解 PTR 的解剖和放射学特征对于手术成功至关重要，而定制的技术流程是一种安全有效的方法，可以进入卵圆孔。
