Percutaneous Balloon Compression Technique using Intraoperative DynaCT for the Treatment of Trigeminal Neuralgia: Technical Note

Percutaneous balloon compression (BC) is a well- established technique that can provide immediate therapeutic relief to patients suffering from trigeminal neuralgia (TN). The general procedure of BC uses fluoroscopy imaging to guide the needle through the foramen ovale (FO). The aim of this study was to describe our experience with a novel technique using intraoperative DynaCT as an adjunct for more accurate guidance of the needle to the FO.

Methods or Case Description:

In this study, DynaCT was used to perform BC in 14 TN cases. The three-dimensional path of the needle was pre-planned using DynaCT and the FO was accessed with needle-guided bi-plane fluoroscopy. DynaCT was used for confirmation of the final position of the needle prior to insertion of the balloon as well as for confirmation of the position of the balloon after inflation.

Outcomes:

DynaCT-guided percutaneous BC allowed for precise placement and positioning of the needle. It facilitated easier cannulation of the FO by providing three-dimensional images for needle guidance. The clinical results were good, and all patients had a quick postoperative recovery. There were no complications.

Conclusion:

The advantages of the DynaCT-guided technique include a single precise needle pass, less trauma, and avoidance of vessel injury. Precise placement of the balloon into different aspects of the foramen ovale can target trigeminal branches more selectively and allow for a better outcome.