3D-CT-assisted stereotactic localization of foramen ovale: a novel puncture technique

Develop a novel stereotactic localization and puncture method based on preoperative image simulation. This method combines dual localization of the foramen ovale's (FO) position and the running angle, aiming to improve the accuracy of finding the foramen ovale for percutaneous procedures in patients with trigeminal neuralgia. The study included 41 patients for whom preoperative three-dimensional computed tomographic reconstruction of the skull base and maxilla was performed using a new method. This method was used to collect the coordinates and course angle of FO based on three-dimensional computed tomography (3D-CT) reconstruction images that could be used to design a puncture path for the FO. A stereotactic frame was used to establish a personalized operative plan. After successful intubation anesthesia, a single puncture was performed targeting the FO with this new method, followed by percutaneous balloon compression for trigeminal neuralgia. All 41 patients successfully accessed the foramen ovale with a single puncture. A satisfactory pear-shaped balloon was achieved in 40 patients, whereas one patient did not attain this outcome. The median surgical time was 46 (range 21–120) minutes. The surgery was well tolerated. 35 patients experienced immediate pain relief, while 6 other patients reported delayed pain relief for approximately 3 days. 8 patients had mild facial paresthesia postoperatively, 4 patients reported perioral herpes with complete resolution of symptoms within one week, 3 patients reported masticatory muscle weakness, and 2 patients reported a decrease in corneal reflex. No major complications were recorded during the follow-up period. Most patients resumed normal activities within three to five days. Based on our preliminary experience, the novel frame-based stereotactic puncture technique for percutaneous balloon compression is useful during these trigeminal neuralgia patients. No.