Acta Neurochirurgica (2025) 167:126
The study revisits Härtel’s technique for percutaneous transoval glycerol injection in treating trigeminal neuralgia. It identifies an optimal entry point in the cheek, 2 mm below the horizontal plane, to improve procedural success and reduce complications, emphasizing the importance of precise needle guidance.
• Purpose: The study revisits Härtel’s technique for percutaneous transoval glycerol injection (GI) to treat trigeminal neuralgia, aiming to identify optimal needle entry points and trajectories using imaging-based simulations.
• Methods: CT and MRI-based simulations were conducted on eleven patients to determine optimal entry points and trajectories through the foramen ovale (FO) to reach Meckel’s cave.
• Findings: The optimal entry point is 2 mm below the horizontal plane through the angle of the mouth, providing better access to Meckel’s cave in most cases.
• Conclusion: Technical results of GI can be improved by selecting the optimal entry point and guiding the needle through the medial part of FO under fluoroscopy.
• Historical Context: Härtel’s technique, developed in 1912, provided a systematic approach to reach the trigeminal ganglion through FO.
• Variability in Techniques: Different variations of GI techniques have led to variable outcomes, highlighting the importance of standardizing the procedure.
• Simulation Insights: 3D simulations help in identifying reliable entry points and can be useful in cases with anatomical variations.
• Clinical Implications: The study suggests that lowering the entry point in the cheek could improve the success rate of GI procedures.
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