• Juan Carlos Acevedo-González and Alex Taub-Krivoy.
• Department of Neurosurgery, Functional Neurosurgery, Pain Management, and Spasticity, San Ignacio University Hospital, Pontifical Xaverian University, Bogotá, Colombia.
• World Neurosurg. 2023 Oct 1; 178: 141914-19.

ObjectiveTo evaluate a modification to the classical Hartel technique for the treatment of trigeminal neuralgia.MethodsIntraoperative radiographs of 30 patients with trigeminal neuralgia treated with radiofrequency were retrospectively reviewed. The distance between the needle and the anterior edge of the temporomandibular joint (TMJ) was measured on strict lateral skull radiographs. Surgical time was reviewed, and clinical outcomes were evaluated.ResultsAll patients showed clinical improvement in pain (Visual Analog Scale). In all radiographs, the measurement between the needle and the anterior edge of the TMJ ranged from 10 mm to 22 mm. None of the measurements were below 10 mm or above 22 mm. In most cases, this distance was 18 mm (9 patients), followed by 16 mm in 5 patients.ConclusionsConsidering the inclusion of the oval foramen in a Cartesian coordinate system with axes X, Y, and Z is useful. Directing the needle to a point located 1 cm from the anterior edge of the TMJ, avoiding the medial aspect of the upper jaw ridge, allows for a safer and faster procedure.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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