Slettebø Haldor, Sakinis Tomas
Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Department of Radiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Acta Neurochir (Wien). 2025 Apr 30;167(1):126. doi: 10.1007/s00701-025-06526-3.
Percutaneous transoval glycerol injection (GI) has been widely used since 1981 in the treatment of patients with trigeminal neuralgia. However, outcomes have been more variable than with other percutaneous treatments. Although most authors state that they use Härtel's technique, the variations are numerous-which may explain procedural problems and most of the poor results. The aim of the present imaging-based study, therefore, was to revisit Härtel's technique and identify optimal landmarks for guiding the needle from the cheek to Meckel's cave.
Eleven patients referred for trigeminal neuralgia were studied. We used CT- and MRI-based simulations to determine the optimal entry points in the cheek and trajectories through foramen ovale (FO) to reach Meckel's cave - and compared our findings with the results from Härtel's original study.
The optimal entry point was located at 2 mm below the horizontal plane through the angle of the mouth and just in front of the anterior edge of the mandibular ramus. From this entry point-situated around 10 mm below Härtel's preferred entry point-Meckel's cave was easily accessible through the medial part of FO in 17 of 22 sides.
The findings from this study suggest that the technical results of transoval glycerol injection can be improved if we 1. Select the optimal entry point, 2. Guide the needle under fluoroscopy through the medial part of the foramen ovale, and 3. Minimize movement of the soft tissues in the cheek.
经皮经卵圆孔甘油注射（GI）自1981年以来已广泛用于治疗三叉神经痛患者。然而，其结果比其他经皮治疗方法的结果更具变异性。尽管大多数作者称他们采用哈特尔技术，但变异情况众多，这可能解释了操作问题以及大多数不佳的治疗结果。因此，本项基于影像学的研究旨在重新审视哈特尔技术，并确定从面颊引导针进入梅克尔腔的最佳标志。
对11例因三叉神经痛前来就诊的患者进行了研究。我们使用基于CT和MRI的模拟来确定面颊的最佳进针点以及经卵圆孔（FO）到达梅克尔腔的路径，并将我们的研究结果与哈特尔原始研究的结果进行比较。
最佳进针点位于通过口角的水平面以下2mm处，恰在下颌支前缘前方。从这个进针点（位于哈特尔首选进针点下方约10mm处），在22侧中的17侧，通过卵圆孔内侧部分可轻松到达梅克尔腔。
本研究结果表明，如果做到以下几点，经卵圆孔甘油注射的技术效果可以得到改善：1. 选择最佳进针点；2. 在荧光镜引导下将针穿过卵圆孔内侧部分；3. 尽量减少面颊部软组织的移动。
