Efficacy and Safety of Awake CT-guided Percutaneous Balloon Compression of Trigeminal Ganglion for Trigeminal Neuralgia.

OBJECTIVES: To describe the method and clinical efficacy of awake CT-guided percutaneous balloon compression (PBC) as a treatment for trigeminal neuralgia (TN).

DESIGN: In this case-series, TN patients were treated with awake CT-guided PBC and followed for treatment efficacy and complications for 12 months.

SETTING: A single-center study.

SUBJECTS: 66 patients with medical treatment-refractory TN were recruited for the study.

METHODS: The procedure was performed under moderate sedation. A balloon catheter was inserted through a trocar needle to reach Meckel's cavity under CT-guidance. The position and optimal shape of the contrast-filled balloon was confirmed with CT 3-dimension reconstruction. Compression of the TG was considered completed when the patient notified operators about facial hypoesthesia or the resolution of TN symptoms. All patients were followed up monthly for 12 months to monitor treatment efficacy and complications.

RESULTS: The average TG compression time was 272±81 seconds, at which point the patients reported significant facial hypoesthesia comparing to the contralateral side or resolution of triggered pain in the affected area. All patients had resolution of TN symptoms for 6 months, with a 1-year recurrent rate of 13%. Overall safety profile is improved with the current technique. Side effects, such as hypoesthesia, and mastication weakness, were overall mild, and did not impact patients' quality-of-life. Some complications that were historically associated with PBC, such as diplopia and keratitis, were not present.

CONCLUSIONS: This new awake CT-guided PBC technique produces better outcomes than the traditional PBC under fluoroscopy-guidance and general anesthesia.