Efficacy and Safety of Awake Computed Tomography-Guided Percutaneous Balloon Compression of Trigeminal Ganglion for Trigeminal Neuralgia

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

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

Setting: A single-center study.

Subjects: A total of 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 were confirmed with CT three-dimensional reconstruction. Compression of the trigeminal ganglion was considered complete 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 trigeminal ganglion compression time was 272 ± 81 seconds, at which point the patients reported significant facial hypoesthesia compared with 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 recurrence rate of 13%. The overall safety profile was improved with the technique described in this study. Side effects, such as hypoesthesia and mastication weakness, were overall mild and did not impact patients' quality of life. Some complications that historically have been 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.