Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.
Oper Neurosurg (Hagerstown). 2024 Mar 1;26(3):279-285. doi: 10.1227/ons.0000000000000975. Epub 2023 Nov 1.
Percutaneous trigeminal rhizotomies are common treatment modalities for medically refractory trigeminal neuralgia (TN). Failure of these procedures is frequently due to surgical inability to cannulate the foramen ovale (FO) and is thought to be due to variations in anatomy. The purpose of this study is to characterize the relationships between anatomic features surrounding FO and investigate the association between anatomic morphology and successful cannulation of FO in patients undergoing percutaneous trigeminal rhizotomy.
A retrospective analysis was conducted of all patients undergoing percutaneous trigeminal rhizotomy for TN at our academic center between January 1, 2010, and July 31, 2022. Preoperative 1-mm thin-cut computed tomography head imaging was accessed to perform measurements surrounding the FO, including inlet width, outlet width, interforaminal distance (a representation of the lateral extent of FO along the middle fossa), and sella-sphenoid angle (a representation of the coronal slope of FO). Mann-Whitney U tests assessed the difference in measurements for patients who succeeded and failed cannulation.
Among 37 patients who met inclusion criteria, 34 (91.9%) successfully underwent cannulation. Successful cannulation was associated with larger inlet widths (median = 5.87 vs 3.67 mm, U = 6.0, P = .006), larger outlet widths (median = 7.13 vs 5.10 mm, U = 14.0, P = .040), and smaller sella-sphenoid angles (median = 52.00° vs 111.00°, U = 0.0, P < .001). Interforaminal distances were not associated with the ability to cannulate FO surgically.
We have identified morphological characteristics associated with successful cannulation in percutaneous rhizotomies for TN. Preoperative imaging may optimize surgical technique and predict cannulation failure.
经皮三叉神经根切断术是治疗药物难治性三叉神经痛（TN）的常用方法。这些手术的失败通常是由于手术无法穿刺卵圆孔（FO）所致，据认为这是由于解剖结构的差异所致。本研究的目的是描述 FO 周围解剖特征之间的关系，并研究在接受经皮三叉神经根切断术的患者中，解剖形态与 FO 穿刺成功之间的关联。
对 2010 年 1 月 1 日至 2022 年 7 月 31 日期间在我们学术中心接受经皮三叉神经根切断术治疗 TN 的所有患者进行回顾性分析。检索术前 1mm 薄层 CT 头部成像以进行 FO 周围测量，包括入口宽度、出口宽度、椎间孔距离（代表 FO 沿中颅窝的外侧范围）和蝶鞍-蝶骨角（代表 FO 的冠状斜率）。Mann-Whitney U 检验评估了成功穿刺和失败穿刺患者的测量值差异。
在符合纳入标准的 37 名患者中，34 名（91.9%）成功进行了穿刺。成功穿刺与更大的入口宽度（中位数=5.87 比 3.67mm，U=6.0，P=0.006）、更大的出口宽度（中位数=7.13 比 5.10mm，U=14.0，P=0.040）和更小的蝶鞍-蝶骨角（中位数=52.00°比 111.00°，U=0.0，P<0.001）相关。椎间孔距离与 FO 手术穿刺能力无关。
我们已经确定了与经皮神经根切断术治疗 TN 中穿刺成功相关的形态特征。术前成像可能会优化手术技术并预测穿刺失败。
