Tag: Percutaneous balloon compression

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Hybrid fluoroscopy–neuronavigation technique for percutaneous balloon compression in trigeminal neuralgia

Acta Neurochirurgica (2026) 168:110

This article presents a hybrid fluoroscopy–electromagnetic neuronavigation technique for percutaneous balloon compression in trigeminal neuralgia, detailing preoperative CT trajectory planning, intraoperative dual guidance, and practical steps to optimize foramen ovale cannulation. Emphasis is placed on safety measures, anesthesia considerations, and procedural specifics such as entry point, stylet use, and balloon inflation parameters.

The manuscript discusses candidate selection, advantages for elderly or comorbid patients, limitations including equipment needs and limited evidence, and practical tips to minimize complications. Key points summarize indications, procedural timing, anatomical landmarks, and the hybrid approach’s potential to shorten the learning curve for junior surgeons.

Purpose: Hybrid fluoroscopy + electromagnetic neuronavigation improves accuracy and safety of foramen ovale cannulation for percutaneous balloon compression in trigeminal neuralgia, reducing multiple passes in anatomically variable cases

Planning: Preoperative thin-slice CT is used to design an individualized needle trajectory to the foramen ovale, sometimes modifying the classical Hartel entry point to avoid bony collision

Anesthesia: Performed under general anesthesia because trigeminal ganglion manipulation can trigger a vagal reflex causing severe bradycardia/asystole; atropine readiness is required

Setup & entry: Patient supine with slight head extension; entry point is typically ~2.5 cm lateral to the oral commissure, with neuronavigation confirming the skin site/trajectory and C-arm fluoroscopy providing real-time position checks

Needle guidance: Needle advanced under fluoroscopy toward the petrous ridge–clivus junction (lateral view alignment), then an electromagnetic sensor/stylet is inserted to confirm and fine-tune alignment with the preplanned path before FO passage

Balloon step: After cannulation, a 4F Fogarty balloon is inflated with ~0.75 ml iopamidol to achieve the characteristic pear-shaped configuration under fluoroscopy

Compression time: Balloon compression is maintained for ~1–3 minutes to balance pain relief with risks such as hypoesthesia and masticatory weakness; limit to a maximum of 3 minutes

Clinical role & limits: Useful for medication-refractory TN, especially elderly/comorbid patients or when MRI shows no neurovascular conflict; limitations include added cost/skill needs and low evidence base (lack of randomized trials)

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Outcomes After Repeat-Percutaneous Balloon Compression for Recurrent Trigeminal Facial Pain

Neurosurgery 97:1012–1020, 2025

This clinical case series evaluates the safety and efficacy of repeat percutaneous balloon compression (PBC) for recurrent trigeminal neuralgia in 36 patients treated from 2019–2023, reporting 55 procedures. Outcomes include pain-free duration, BNI pain scores, facial numbness, medication reduction, operative metrics, and complications, with midterm follow-up averaging 33 months.

Key findings indicate repeat PBC yields durable pain relief for most patients (72% sustained complete relief), enables medication reduction in 71%, and incurs low complication rates without observed deafferentation pain; multiple sclerosis patients required more repeats but benefited similarly. The study calls for larger comparative trials to confirm these single-center results.

• Repeat Percutaneous Balloon Compression (PBC) Efficacy: Repeat PBC procedures are effective in managing recurrent trigeminal neuralgia, with 72% of patients maintaining complete pain relief at midterm follow-up (mean: 33 months), and 71% able to permanently decrease or eliminate facial pain medications.

• Safety of Repeat PBC: Repeat PBCs do not increase the risk of complications, regardless of the number of procedures or balloon inflation time, and no patients experienced deafferentation pain in this cohort.

• Complication Profile: Minor transient complications occurred in 10.9% of procedures, with only one major complication (carotid artery puncture); most adverse effects were temporary and non-severe, such as transient numbness, chewing difficulties, or partial corneal anesthesia.

• Pain-Free Interval: The mean pain-free interval after the first PBC was 18 months, with longer intervals observed after subsequent procedures (second: 20 months, third: 41 months in one case), and a decreasing proportion of patients requiring further interventions with each repeat procedure.

• Patient Selection and Outcomes: PBC was performed in patients with predominantly neuralgic facial pain who were not candidates for microvascular decompression; patients with multiple sclerosis (MS) required more repeat procedures but still achieved high rates of pain relief.

• Comparison to Other Techniques: Compared to other percutaneous procedures like radiofrequency thermocoagulation (RFT) and glycerol rhizotomy, repeat PBC appears to have fewer severe complications such as deafferentation pain, dysesthesia, or persistent sensory deficits.

• Balloon Compression Time: Longer balloon inflation times (up to 10 minutes for repeat procedures) did not correlate with increased complications and may contribute to longer pain-free intervals, though no statistical significance was found in this study.

• Clinical Recommendation: Given the likelihood of recurrence after percutaneous procedures, PBC is a safe and effective option for recurrent trigeminal neuralgia, especially for patients unsuitable for more invasive surgery, but larger multi-institutional studies are needed for broader validation.

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Perioperative Evaluation and Monitoring of Percutaneous Balloon Compression in Treatment of Trigeminal Neuralgia

Operative Neurosurgery 29:263–270, 2025

This prospective study found that higher intraluminal balloon pressure during percutaneous balloon compression for trigeminal neuralgia reduces long-term pain recurrence without increasing persistent facial numbness. Preoperative MRI-based Meckel’s cave assessment and intraoperative pressure monitoring help optimize outcomes and balance pain relief with sensory side effects.

• Percutaneous balloon compression (PBC) is used to treat trigeminal neuralgia (TN), with outcomes influenced by intraluminal balloon pressure, balloon volume, and Meckel’s cave volume.

• Preoperative high-resolution MRI enables 3D reconstruction of Meckel’s cave, aiding in predicting intraoperative balloon volume.

• Intraoperative monitoring of balloon pressure and volume was performed in 37 patients; primary outcomes were facial numbness and pain recurrence up to 24 months.

• Facial numbness was common in the first month (38%), but typically resolved by 24 months; numbness was not linked to balloon pressure.

• TN recurrence rate was about 25% at 24 months and was significantly associated with lower intraluminal balloon pressure.

• No significant differences in Meckel’s cave or balloon volume were observed between subgroups, but Meckel’s cave volume correlated positively with balloon volume.

• Authors recommend maintaining intraluminal balloon pressure around 135.7 ± 27.1 kPa (with 120 seconds compression) to minimize recurrence without increasing sensory deficits.

• Perioperative assessment of balloon compression (including MRI and pressure monitoring) is feasible and may help balance TN recurrence risk and sensory complications.

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