• Bradley N Bohnstedt, R Shane Tubbs, and Aaron A Cohen-Gadol.
• Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana 46202, USA.
• Neurosurgery. 2012 Jun 1;70(2 Suppl Operative):177-80.

BackgroundWe describe the use of an intraoperative CT scan obtained using the Medtronic O-arm (Littleton, Massachusetts) for image-guided cannulation of the foramen ovale not previously accessible with the use of fluoroscopy alone. Unlike previously described procedures, this technique does not require placement of an invasive head clamp and may be used with an awake patient.ObjectiveTo describe the use of intraoperative neuronavigation for accessing skull base foramina and, specifically, cannulating of the foramen ovale during percutaneous rhizotomy procedures using an intraoperative image guidance CT scanner (Medtronic O-arm, Littleton, Massachusetts).MethodsA noninvasive Landmark Fess Strap attached to a spine reference frame was applied to the heads of 4 patients who harbored a difficult-to-access foramen ovale. An intraoperative HD3D skull base scan using a Medtronic O-arm was obtained, and Synergy Spine software was used to create 3D reconstructions of the skull base. Using image guidance, we navigated the needle to percutaneously access the foramen ovale by the use of a single tract for successful completion of balloon compression of the trigeminal nerve.ResultsAll 4 patients (3 females and 1 male; ages 65-75) underwent the procedure with no complications.ConclusionBased on our experience, neuronavigation with the use of intraoperative O-arm CT imaging is useful during these cases.

27 keywords...

hide…