Carotid-cavernous fistula following percutaneous trigeminal ganglion approach

Gökalp, Hamit Z.; Kanpolat, Yücel; Tümer, B.

doi:10.1016/0303-8467(80)90019-0

Cited by 47 publications

(27 citation statements)

References 8 publications

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“…Facial hypoesthesia, injury to the cranial nerves, abscess and failure of the treatment are the most frequent complications of percutaneous procedures, regardless of the type. Vascular complications are rare and include stroke, haematoma and subarachnoid haemorrhage [1][2][3][4][5][6][7][8][9][10]. However, the occurrence of an arteriovenous fistula following glycerol injection is an unusual complication, and to our knowledge, this was never described before.…”

Section: Introductionmentioning

confidence: 76%

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Middle Meningeal Arteriovenous Fistula Following Percutaneous Retrogasserian Glycerol Rhizotomy

Champeaux

Shieff

2015

Clin Neuroradiol

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Section: Introductionmentioning

confidence: 76%

“…Twelve AVF complications following percutaneous retrogasserian procedures have been reported, of which four originating from the ECA (Table 1) [1][2][3][4][5][6][7][8][9][10]. Incidence of fistula creation is probably very rare and most likely anecdotal.…”

Section: Discussionmentioning

confidence: 99%

Middle Meningeal Arteriovenous Fistula Following Percutaneous Retrogasserian Glycerol Rhizotomy

Champeaux

Shieff

2015

Clin Neuroradiol

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“…Once the needle pierces the FO, numerous complications can arise from the medial or lateral displacement of the needle as well as deeper insertion. A carotid-cavernous fistula is an uncommon but severe complication of the procedure 10,21,24,26,39 and can be related to a tip displaced medial to the petrolingual ligament. In our study, the safe region would be more than 18 mm from midline in the AP view, and was 18 mm in only 1 (1.26%) of 79 skull sides, but the average distance from the petrolingual ligament to midline was 15.55 mm.…”

Section: Injury To Intracranial Structures Due To Incorrectmentioning

confidence: 99%

Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications

Peris-Celda

Graziano

Russo

et al. 2013

JNS

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F oramen ovale puncture was first described by Här-tel in 1914 18 as a percutaneous route to the Meckel cave to treat trigeminal neuralgia. Microvascular decompression induces little or no hypesthesia and is usually the treatment of choice for young patients without comorbidities.3 However, less invasive techniques, including FO puncture, are preferred Object. Foramen ovale (FO) puncture allows for trigeminal neuralgia treatment, FO electrode placement, and selected biopsy studies. The goals of this study were to demonstrate the anatomical basis of complications related to FO puncture, and provide anatomical landmarks for improvement of safety, selective lesioning of the trigeminal nerve (TN), and optimal placement of electrodes.Methods. Both sides of 50 dry skulls were studied to obtain the distances from the FO to relevant cranial base references. A total of 36 sides from 18 formalin-fixed specimens were dissected for Meckel cave and TN measurements. The best radiographic projection for FO visualization was assessed in 40 skulls, and the optimal trajectory angles, insertion depths, and topographies of the lesions were evaluated in 17 specimens. In addition, the differences in postoperative pain relief after the radiofrequency procedure among different branches of the TN were statistically assessed in 49 patients to determine if there was any TN branch less efficiently targeted.Results. Most severe complications during FO puncture are related to incorrect needle placement intracranially or extracranially. The needle should be inserted 25 mm lateral to the oral commissure, forming an approximately 45° angle with the hard palate in the lateral radiographic view, directed 20° medially in the anteroposterior view. Once the needle reaches the FO, it can be advanced by 20 mm, on average, up to the petrous ridge. If the needle/radiofrequency electrode tip remains more than 18 mm away from the midline, injury to the cavernous carotid artery is minimized. Anatomically there is less potential for complications when the needle/radiofrequency electrode is advanced no more than 2 mm away from the clival line in the lateral view, when the needle pierces the medial part of the FO toward the medial part of the trigeminal impression in the petrous ridge, and no more than 4 mm in the lateral part. The 40°/45° inferior transfacial-20° oblique radiographic projection visualized 96.2% of the FOs in dry skulls, and the remainder were not visualized in any other projection of the radiograph. Patients with V1 involvement experienced postoperative pain more frequently than did patients with V2 or V3 involvement. Anatomical targeting of V1 in specimens was more efficiently achieved by inserting the needle in the medial third of the FO; for V2 targeting, in the middle of the FO; and for V3 targeting, in the lateral third of the FO.Conclusions. Knowledge of the extracranial and intracranial anatomical relationships of the FO is essential to understanding and avoiding complications during FO puncture. These data suggest that better rad...

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“…Caroticocavernous fistula due to internal carotid artery (ICA) rupture, temporary or persistent pareses of the cranial nerves, cerebrospinal fluid (CSF) fistula and intracranial haemorrhages are wellknown complications of trigeminal rhizotomy. [1][2][3][4][5][6] The aim of the present study is to define the mechanisms of complications of transovale procedures using dry skull measurements and cadaver dissections of the region.…”

Section: Introductionmentioning

confidence: 99%