Dyna-CT-Guided Percutaneous Balloon Compression for Trigeminal Neuralgia: Technical Nuances and a Single-Institution Experience

Introduction: Trigeminal neuralgia (TN) is a debilitating facial pain syndrome often unresponsive to medical therapy. Percutaneous balloon compression (PBC) provides a minimally invasive treatment with immediate results. Traditionally, this procedure is performed in the operating room with C-arm fluoroscopy, which can be challenging due to anatomical variations and limited visualization. Our institution performs all PBCs in the angio suite using Dyna-CT-Guided imaging for real-time, high-resolution confirmation of needle and balloon placement in the foramen ovale. This study reviews the Dyna-CT-Guided PBC technique with discussion of its safety and outcomes between 2020-2024.

Methods: Patients who underwent Dyna-CT-Guided PBC for refractory TN were retrospectively identified. Procedures were performed under general anesthesia using a 14-gauge lumbar drain needle and 4F Fogarty balloon. Needle entry was made 3-cm lateral to the labial fold, guided through the cheek to the pterygoid fossa and foramen ovale under fluoroscopy. Dyna-CT confirmed needle position and balloon placement upon inflation in Meckel’s cave. Pre-operative MRI was fused with Dyna-CT to evaluate balloon proximity to critical structures.

Results: There were 30 PBC procedures in 21 patients with 8 repeat cases. Dyna-CT confirmed accurate needle placement on the first scan in 57% of cases, averaging 2.5 scans per procedure. Fluoroscopy time was 6.744.39 minutes with a total dose of 422.17±177.69 mGy. Acute pain relief was achieved in 83.3% of cases, with symptoms recurrent in 14 cases after 9.5±11.33 months. Minor numbness occurred in 0.1% of cases with one instance of hyperesthesia. All elective cases were discharged home the same day.

Conclusion : Dyna-CT-guided PBC is a precise, safe, and effective option for refractory TN that is suitable for the angio suite. Combining 2D/3D imaging with MRI fusion enhances needle accuracy. Although other treatment options may have longer efficacy, PBC is valuable for high-risk surgical candidates or those with rapid acuity of symptoms.