Relative location of foramen ovale, foramen lacerum, and foramen spinosum in Hartel pathway.

Trigeminal neuralgia is a common disease in Chinese people. Minimal invasive transforaminal pathway is widely used in treating trigeminal neuralgia. The Hartel pathway is the most commonly used operation route, but it has potential to injure vessels such as arteria meningea media and the internal carotid artery. We measured the location of operation route, foramen spinosum, and foramen lacerum in a three-dimensional pattern. We found that to protect those 2 vessels, the angle and depth of puncture should be well regulated. The horizontal component of the angle between the needle axis and y axis should be more than 22 degrees in women and 20 degrees in men to avoid the injury of arteria meningea media. And for protecting the internal carotid artery, the depth of puncture should be less than 85 mm for women and 93 mm for men, or less than 9 mm after penetrating the meninges.