Predicting balloon shape in percutaneous microcompression : an observational comparative analysis of Meckel's cave imaging and balloon morphology.

Achieving a pear-shaped balloon holds pivotal significance in the context of successful percutaneous microcompression procedures for trigeminal neuralgia. However, inflated balloons may assume various configurations, whether it is inserted into Meckel's cave or not. The absence of an objective evaluation metric has become apparent. To investigate the relationship between the morphology of Meckel's Cave and the balloon used in percutaneous microcompression for trigeminal neuralgia and establish objective criteria for assessing balloon shape in percutaneous microcompression procedures. This retrospective study included 58 consecutive patients with primary trigeminal neuralgia. Data included demographic, clinical outcomes, and morphological features of Meckel's cave and the balloon obtained from MRI and Dyna-CT imaging. MRI of Meckel's cave and Dyna-CT of intraoperative balloon were modeled, and the morphological characteristics and correlation were analyzed. The reconstructed balloon presented a fuller morphology expanding outward and upward on the basis of Meckel's cave. The projected area of balloon was strongly positively correlated with the projected area of Meckel's cave. The Pearson correlation coefficients were 0.812 (P<0.001) for axial view, 0.898 (P<0.001) for sagittal view and 0.813 (P<0.001) for coronal view. Similarity analysis showed that the sagittal projection image of Meckel's cave and that of the balloon had good similarity. This study reveals that the balloon in percutaneous microcompression essentially represents an expanded morphology of Meckel's cave, extending outward and upward. There is a strong positive correlation between the volume and projected area of the balloon and that of Meckel's cave. Notably, the sagittal projection image of Meckel's cave serves as a reliable predictor of the intraoperative balloon shape. This method has a certain generalizability and can help providing objective criteria for judging balloon shape during percutaneous microcompression procedures.

Enhancing Visualization of the Foramen Ovale in Percutaneous Microcompression: A Preoperative Image Simulation Technique.

OBJECTIVE: Introducing a preoperative image simulation technique to streamline the visualization of the foramen ovale in percutaneous microcompression. METHODS: Twenty-five trigeminal neuralgia patients were included in the study. Preoperative cranial computed tomography scans were processed with 3D Slicer software to create simulated fluoroscopic skulls. The angulations required for precise visualization of the foramen ovale were established via simulated anteroposterior imaging. These simulations informed the C-arm's angulations for foramen ovale targeting during surgery. RESULTS: The preoperative simulations accurately forecasted skull rotation angulations, aligning closely with intraoperative observations with negligible discrepancies (0-2 degrees). In 17 patients, the foramen ovale was distinctly visible, while in 8 patients, it was partially obscured yet discernible using the simulated angles. Nonvisible of the foramen ovale did not occur. Postoperative pain relief and complications were recorded. CONCLUSIONS: Based on our initial findings, the application of preoperative image simulation shows significant referential value in achieving accurate visualization of the foramen ovale in percutaneous microcompression for trigeminal neuralgia.

Chinese expert consensus on minimally invasive interventional treatment of trigeminal neuralgia.

Background and purpose: Trigeminal neuralgia is a common condition that is associated with severe pain, which seriously affects the quality of life of patients. When the efficacy of drugs is not satisfactory or adverse drug reactions cannot be tolerated, minimally invasive interventional therapy has become an important treatment because of its simple operation, low risk, high repeatability and low cost. In recent years, minimally invasive interventional treatments, such as radiofrequency thermocoagulation (RF) of the trigeminal nerve and percutaneous microcompression (PMC), have been widely used in the clinic to relieve severe pain in many patients, however, some related problems remain to be addressed. The Pain Association of the Chinese Medical Association organizes and compiles the consensus of Chinese experts to standardize the development of minimally invasive interventional treatment of trigeminal neuralgia to provide a basis for its clinical promotion and application. Materials and methods: The Pain Association of the Chinese Medical Association organizes the Chinese experts to compile a consensus. With reference to the evidence-based medicine (OCEBM) system and the actual situation of the profession, the Consensus Development Committee adopts the nominal group method to adjust the recommended level. Results: Precise imaging positioning and guidance are the keys to ensuring the efficacy and safety of the procedures. RF and PMC are the most widely performed and effective treatments among minimally invasive interventional treatments for trigeminal neuralgia. Conclusions: The pain degree of trigeminal neuralgia is severe, and a variety of minimally invasive intervention methods can effectively improve symptoms. Radiofrequency and percutaneous microcompression may be the first choice for minimally invasive interventional therapy.

Effect of Percutaneous Microcompression in Trigeminal Neuralgia: Case report / 대한마취과학회지

There are many surgical alternatives to medical therapy for trigeminal neuralgia. Among open procedures, Jannetta's procedure for microvascular decompression have widest favor. But there is no justification for exposing patients to such dangers when there are effective and safe alternatives such as percutaneous procedures. Of the percutaneous procedures, the most widely used are thermocoagulation, glycerolization, and microcompression of the gasserian ganglion. Percutaneous microcompression of the gasserian ganglion was introduced by Mullan in 1978 and its description was published in 1983. In the 1950's and 1960's deliberate compression of the gasserian ganglion was performed through an open operation. Mullan carried out this precedure using an inflatable balloon under brief anesthesia. 15 procedures were performed under brief general anesthesia in order to ensure maximum comfort for the patient in the operating room. The instruments consisted of a 14 gauge blunt tip needle, a 4F Fogarty catheter and a tuberculin syringe. The compression was maintained usually for 1 to 1.5 minutes. 14 out of 15 patients were relieved from their pain without serious complications.

Analysis of Ballon Volumes Used during Percutaneous Microcompression of the Gasserian Ganglion for Trigeminal Neuralgia in Korean Patients / 대한마취과학회지

BACKGROUND: Balloon volume is a very important factor in microcompression of the gasserian ganglion. Up until now, the range of figures for balloon inflation volumes came from foreign data. Experience has shown that the optimal range of balloon inflation volumes is somewhat different in Korean patients. Our aim was to determine mean, minimal, and maximal volumes among Korean patients. METHODS: In each case balloon volume was measured when protrusion through the porus trigemini occurred. From a total of thirty-three cases seen over a one year period, thirty will be considered here. The remaining three were excluded because of unsuccessful outcomes due to improper positioning of the balloon. This resulted in extreme balloon volumes in these three cases. RESULTS: The values determined from this group of patients were as follows: the mean was 0.55 ml, the maximum was 1.0 ml, and the minimum was 0.35 ml. The mean was 0.75 ml for males and 0.50 ml for females. However due to differences in age and height, this variation in the mean was not statistically significant. CONCLUSIONS: Although a comparison of the mean values is not possible because it has never been reported before now in foreign articles, the balloon volumes measured in Korean patients are generally smaller than those reported from Europe and North America.