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Percutaneous balloon compression technique using intraoperative contrasted DynaCT for the treatment of refractory trigeminal neuralgia: initial experience

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Abstract

Objective

Percutaneous balloon compression (BC) is a well-established technique that can provide immediate 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 contrast-enhanced DynaCT as an adjunct for more accurate and safer guidance of the needle to the FO.

Methods

In this study, DynaCT was used to perform BC in 20 TN cases. The three-dimensional path of the needle was pre-planned using DynaCT obtained during the administration of IV contrast. The FO was accessed in a single pass along the path pre-determined from the DynaCT images, avoiding any major arteries and veins. DynaCT was also 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.

Results

Intravenous contrast-enhanced DynaCT-guided percutaneous BC allowed precise advancement and positioning of the needle within the FO. It facilitated cannulation of the FO along a pre-determined path that avoided any major vascular structures. Clinical outcomes were excellent—all patients had a quick postoperative recovery, and there were no complications.

Conclusions

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

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Data availability

Anonymized data will be shared by request from any qualified investigator upon reasonable request.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Aakangsha Jain and Bilal Ibrahim contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Aakangsha Jain, Bilal Ibrahim, Assad Ali, Baha’eddin A. Muhsen, Edinson Najera, Badih Adada, Hamid Borghei-Razavi & Michal Obrzut

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  1. Aakangsha Jain
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  2. Bilal Ibrahim
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  3. Assad Ali
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Contributions

Aakangsha Jain: data collection, data analysis, writing the manuscript.

Bilal Ibrahim: data collection, data analysis, writing the manuscript.

Assad Ali: writing and review the manuscript.

Baha’eddin A. Muhsen: participated in the study design, review the manuscript.

Edinson Najera: participated in the study design, review the manuscript.

Badih Adada: supervised the whole study and critically revised the manuscript.

Hamid Borghei-Razavi: contributed to study design, critically revised the manuscript.

Michal Obrzut: contributed to study design, critically revised the manuscript.

All the authors revised and approved the final manuscript version.

Corresponding authors

Correspondence to Hamid Borghei-Razavi or Michal Obrzut.

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Ethics approval

Approval for this retrospective study of a consecutive case series was obtained from relevant institutional research ethics boards.

Conflict of interest

The authors declare no competing interests.

Consent to participate

Patient consent was waived due to the study design.

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I, Hamid Borghei-Razavi, on behalf of all authors, give my consent for the publication of identifiable details, which can include images and/or videos and/or details within the text to be published in the journal Neurosurgical Review.

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Jain, A., Ibrahim, B., Ali, A. et al. Percutaneous balloon compression technique using intraoperative contrasted DynaCT for the treatment of refractory trigeminal neuralgia: initial experience. Neurosurg Rev 45, 1393–1399 (2022). https://doi.org/10.1007/s10143-021-01649-4

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  • DOI: https://doi.org/10.1007/s10143-021-01649-4

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