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A new guidance device facilitates percutaneous puncture of the foramen ovale in human cadavers

[Un nouveau guidage facilite la ponction percutanée du foramen ovale chez les cadavres humains]

Martin Hinteregger^*, Fritz Zschiegner^*, Philipp Lirk, MD^*,, Eugen Ladner, MD^*, Albert Goeschl, MB^*, Othmar Gaber, MD, Patrizia Moser, MD, Ingo Lorenz, MD^* and Christian Kolbitsch, MD DEAA^*

^* From the Departments of Anesthesiology and Critical Care Medicine, and
Pathology, and
the Institute of Anatomy, Histology & Embryology, Medical University of Innsbruck, Innsbruck, Austria; and
the Department of Anesthesiology, Medical College of Wisconsin, Wisconsin, USA.

Address correspondence to: Dr. Philipp Lirk, Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Phone: 43-512-504-80479; Fax: 43-512-504-22450; E-mail: philipp.lirk{at}uibk.ac.at

Purpose: Trigeminal neuralgia is the most common neurological cause for facial pain. Contemporary interventional treatment relies on surgical microvascular decompression or, alternatively, percutaneous interventions targeting the semilunar ganglion via the foramen ovale. For the latter approach, only free-hand punctures using fluoroscopy devices have been reported. Therefore, the present study aimed to evaluate a new fluoroscopy-based guidance device for transforaminal puncture.

Methods: Two experienced examiners punctured the foramen ovale bilaterally free-hand, and using a guidance device in human cadavers (n = 9). The number of attempts for puncture was recorded. A new attempt was counted each time the needle had to be retracted for redirection.

Results: As compared to the free-hand puncture of the foramen ovale (4.44 ± 2.79), the new guidance device significantly reduced the number of trials needed (1.37 ± 0.69).

Conclusion: The employment of a guidance device facilitated percutaneous transforaminal puncture and resulted in a significantly decreased number of puncture attempts as compared to free-hand techniques in human cadavers.