Anatomical Study of Percutaneous Trigeminal Compressive Balloon Positioning on Merged 3-D Rotational X-Ray and Preprocedural Magnetic Resonance Imaging

Abstract

Background: Percutaneous trigeminal rhizotomy or balloon compression for trigeminal neuralgia carries a potential risk for the brainstem, the carotid artery, and the basilar artery. Objective: To detail the relation of critical neural and vascular structures to expanded balloons used for percutaneous compression of the trigeminal ganglion. Method: A retrospective analysis of preprocedural magnetic resonance imaging (MRI) and procedural X-ray-based imaging for 9 patients detailed balloon proximity to the brainstem, carotid artery, and basilar artery. Results: Balloons extended 10.96 ± 5.54 mm (mean ± SD) posterior to the clival line. The average distance from the balloon to the brainstem was 6.89 mm, and that to the basilar artery was 12.12 mm (range: 0–18.2). The medial edge of the balloon was an average distance of 1.39 mm from the baseline position of the carotid lumen. Conclusion: Preprocedural MRI, merged with 3-D rotational angiography suite imaging, detailed the proximity of the balloon to critical neural and vascular structures. Our study found that the standard technique for percutaneous trigeminal compression, with balloon placement at an average depth of 10.96 mm posterior to the clival line, on average, provided an additional 6.89 mm of space before the brainstem would have been encountered, demonstrating safe positioning.

Robot-Assisted Percutaneous Balloon Compression in Elderly Patients with Trigeminal Neuralgia

“…9 Long-term clinical practice has shown that if the quality of PBC surgery and effective "pear formation" is ensured, then better pain relief rates and lower recurrence rates can be obtained. [10][11][12] Traditional PBC surgery is performed under the guidance of X-ray or CT, [13][14][15][16][17] although lateral X-ray alone can only provide two-dimensional non-sectional images and cannot fully display the complex skull base bony structure and foramen ovale. However, using various improved CT-guided techniques 18,19 or surgery under electromagnetic navigation 20,21 still relies on the operator's free-hand operation and lacks the constraints of a fixed frame.…”