Air-to-Air Meeting Technique in Radiofrequency Thermocoagulation of Trigeminal Neuralgia: A Case Report.

BACKGROUND

In a minority of cases, foramen ovales (FOs) are difficult to access due to single confounding anatomical variations. However, there is no method reported where the FO has been successfully targeted via a single puncture in the presence of two or more anatomical variations.

OBJECTIVES

To observe the effect of a new stereotactic bidirectional approach guiding technique utilized in a patient who harbored a particularly difficult-to-access FO due to multiple anatomical variations.

METHODS

During operation of a unique facial entry point's trigeminal neuralgia patient, make one plane which identified by a three-dimensional (3D) coordinates of the FO target and arc angle value on stereotactic frame, make this plane intersected with another plane which determined by the 3D CT-reconstruction's facial entry point data on a ruler, so as to elucidate the appropriate trajectory. The authors coined the approach "Air-to-air meeting" method.

RESULTS

We completed the radiofrequency thermocoagulation (RFT) with a single puncture to successfully target the FO according to the preoperative plan confirmed by C-arm radiography. Postoperative pain scores using a visual analog scale decreased from 10 to 3 by the first day after the procedure. There were no permanent complications or morbidity from the surgery.

CONCLUSIONS

To the authors' knowledge, this is the first report describing a unique facial entry point determined by this technique for the treatment of a patient with trigeminal neuralgia.