Alternative customized instrumentation and technique for percutaneous balloon compression rhizotomy for trigeminal neuralgia

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Trigeminal neuralgia is a debilitating disease that can be treated effectively by a number of modalities. Percutaneous balloon compression rhizotomy of the gasserian ganglion is an important technique that can be offered as a primary or secondary strategy after failure of medical therapy. However, the commercial kit for this procedure was discontinued in the United States in early 2016 and therefore is not currently available. The authors describe a low-cost, effective solution for continuing to offer this procedure using equipment already available in most hospitals.


The authors provide a detailed equipment list with step-by-step instructions on how to prepare all the necessary items and perform a percutaneous balloon compression rhizotomy.


The custom “homemade” kit and technique described have been utilized successfully since June 2016 in 34 patients. The kit is a low-cost alternative, and its application does not add any operative time beyond that required for the previously commercially available kit.


Percutaneous balloon compression rhizotomy of the gasserian ganglion is an important technique that should be readily available to patients who are not medically fit for microvascular decompression and need immediate relief of their pain. The alternative kit described here can be assembled easily using equipment that is readily available in most hospitals.

ABBREVIATIONS EVD = external ventricular drain.

Article Information

Correspondence Aaron A. Cohen-Gadol: Goodman Campbell Brain and Spine, Indiana University, Indianapolis, IN.

INCLUDE WHEN CITING Published online May 10, 2019; DOI: 10.3171/2019.2.JNS182896.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    Components of the prepared customized kit. Figure is available in color online only.

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    Placement of the Tru-Cut cannula and removal of its stylet. Figure is available in color online only.





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