Joe Iwanaga1, Filippo Badaloni2, Tyler Laws3, Rod J Oskouian3, R Shane Tubbs4. 1. Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan. Electronic address: joei@seattlesciencefoundation.org. 2. Neurosurgery Department, Santa Corona Hospital, Pietra Ligure, SV, Italy. 3. Seattle Science Foundation, Seattle, Washington, USA. 4. Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: E Suero Molina; J M Revuelta Barbero; C Ewelt; W Stummer; R L Carrau; D M Prevedello Journal: Neurosurg Rev Date: 2020-02-10 Impact factor: 3.042