Trigeminal Neuralgia-Step-by-Step DYNA-Computed Tomography-Assisted Balloon Compression Rhizotomy

Area of Science:

• Neurosurgery
• Interventional Radiology
• Medical Imaging

Background:

• Trigeminal neuralgia (TN) is a debilitating condition often treated with trigeminal nerve balloon compression (TNBC).
• TNBC is a valuable option for patients unsuitable for surgery or those with inadequate response to other treatments.
• Intraoperative imaging is crucial for precise needle placement in TNBC.

Discussion:

• Intraoperative computed tomography-like images using a C-arm system (DYNA-CT) significantly facilitate the TNBC procedure.
• Three-dimensional DYNA-CT imaging with needle guidance enables precise needle advancement through the foramen ovale.
• DYNA-CT allows direct visualization and avoidance of critical vascular structures, reducing procedural risks and time.

Key Insights:

• DYNA-CT needle guidance ensures accurate needle trajectory and balloon positioning within the Meckel cave.
• This technique demonstrably reduces fluoroscopy dose and time compared to conventional methods.
• Operator radiation exposure is minimized as the neurointerventional team can be outside the room during DYNA-CT acquisition.

Outlook:

• DYNA-CT needle guidance represents a safe and feasible advancement for TNBC procedures.
• The technique holds potential for wider adoption, improving outcomes for trigeminal neuralgia patients.
• Further integration of advanced imaging in neurointerventional procedures is anticipated.