Skull Base Vascular Anatomy of the Infratemporal Fossa Pertinent to Percutaneous Access to the Foramen Ovale for Treatment of Trigeminal Neuralgia: A Comparison of Cadaveric Dissection and Computed Tomography Analysis

Objective: Trigeminal neuralgia (TN) may be treated via percutaneous access to the foramen ovale (FO). Vascular complications associated with the needle trajectory, though rare, can result in serious morbidity and mortality. This study aimed to correlate the vascular relations of the FO at the skull base via cadaveric dissections and computed tomography (CT) imaging.

Methods: Two fresh cadaver heads were injected with red and blue latex to delineate arteries and veins, respectively. Neck and infratemporal fossa dissections were then performed to delineate the vascular relations of the FO. High-resolution CT imaging was collected from adult patients undergoing imaging for neurosurgical evaluation/procedures. Axial imaging was used to delineate distances between skull base foramen.

Results: Three infratemporal fossa (two cadaveric specimens) were dissected. The mean distance of FO to the internal carotid artery (ICA) and FO to the middle meningeal artery (MMA) was 2.4 ± 0.12 and 0.8 ± 0.16 cm, respectively. Fifty-two high-resolution CT images (104 sides) with 1-mm axial slices were analyzed. The area of the FO was 31.1 ± 9.6 mm². The distance of the FO to the ICA and the FO to the MMA was 1.70 ± 0.31 and 0.73 ± 0.61 cm, respectively.

Conclusion: Delineation of vascular structures in the infratemporal fossa correlates between cadaveric dissection and axial CT imaging. Inadvertent cannulation of the ICA using standard percutaneous techniques to FO for treatment of TN is rare, and vascular structures at risk are the middle meningeal and branches of the maxillary arteries. CT imaging is readily available and may be sued to better inform specific anatomical relations in a patient-to-patient basis.

Publication History

Article published online:
12 February 2021