An Image-guided, Noninvasive Method of Cannulation of the Foramen Ovale for Awake, Percutaneous Radiofrequency Rhizotomy

The authors describe a simple and low-cost technique for image-guided cannulation of the foramen ovale during treatment of medically refractory trigeminal neuralgia using percutaneous radiofrequency rhizotomy. Computed tomography-guided neuronavigation and the noninvasive ear, nose, and throat Small Active Frame system were applied for visualization of cannulation of the foramen ovale in the awake patient. Use of invasive head-clamp fixation was unnecessary. Three patients were treated using this technique in which the foramen ovale was reached using a single tract. No adverse effects of this technique were reported. The potential benefits and disadvantages of this method are presented.