Dyna-CT as an Imaging Adjunct to Routine Percutaneous Balloon Compression for Trigeminal Neuralgia

Objective and Importance: Intraprocedural three-dimensional (3D) axial tomography reconstructions have improved aneurysm detection, pedicle screw placement and more, resulting in less morbidity and improved outcomes. Currently, relative to balloon compression for trigeminal neuralgia, we are dependent upon lateral 2-dimensional imaging for the classic ‘pear shape’ imaging to determine correct positioning. ClinicalPresentation: Our patient was a 97-year-old woman with a 4-year history of V2 and V3 intermittent severe pain with typical features of trigeminal neuralgia. Intervention: After induction of anesthesia on the Dyna-CT (Siemens) angiogram table, Meckl’s cave was accessed as guided by fluoroscopy, a 4-French Fogarty catheter was introduced, and its balloon was inflated tightly for 90 s with soluble contrast agent to compress the gasserian ganglion. As would be done for 3D angiogram, the Dyna-CT was used to perform image acquisition for image reconstruction. Two additional cases are supplied to show the variability of volume filling of the balloon compression. Conclusion: We speculate that 3D reconstructions of percutaneous balloon compression of the trigeminal ganglion may aid in the identification of an ideal balloon configuration of a volume which could impact the outcome, or perhaps reduce complications such as masseter weakness or dysesthesias. Here we show the first clinical images available demonstrating volumetric reconstruction of a balloon compression for trigeminal neuralgia utilizing Dyna-CT.