Microsurgical anatomy of the transoval percutaneous route to the trigeminal cave and the trigeminal ganglion

The percutaneous Hartel transoval route goes through an inverted pyramid, with an inferior summit and a superior base that includes three compartments. The danger of the inferior compartment is the parotid duct. The middle compartment contains many branches of the mandibular nerve. The superior compartment is crossed by the internal maxillary artery and its branches. as well as the auditory tube. The base of the pyramid presents not only the foramen ovale. but also the foramen lacerum. where the trocar may injure the internal carotid. and the foramen jugulare, where the trocar may meet the internal jugular vein and nerves of the pars nervosa (IX, X, XI). The trigeminal cave contains. within the trigeminal cistern. the trigeminal ganglion, extended backward by the triangular plexus (the target for thermocoagulation). These structures are undercrossed by the masticatory motor branch of the trigeminal nerve. (C) 2009 Elsevier Masson SAS. All rights reserved.