Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia

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✓ Fifty patients were treated for trigeminal neuralgia by percutaneous microcompression of the trigeminal ganglion. A No. 4 Fogarty balloon catheter was inserted under brief general anesthesia, using biplane fluoroscopy. This procedure is essentially a percutaneous simplication of the older Taarnhøj-Sheldon-Pudenz operation. The follow-up period ranged from 0.5 to 4.5 years. Pain recurred in 12% of cases during that time, and it is anticipated that within 5 years the recurrence rate will reach 20%, which is approximately the same rate as for the alternative established procedures. The advantages of this technique are freedom from discomfort on the part of the patient, a remarkable ease of performance on the part of the operator, absence of associated mortality, and a minimal morbidity rate.

Article Information

Address reprint requests to: Sean Mullan, M.D., Section of Neurological Surgery, The University of Chicago Hospitals, 950 East 59th Street, Chicago, Illinois 60637.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Radiograph showing satisfactory placement of the balloon. Note the needle does not enter the skull. The balloon has assumed the “pear” shape as it engages in the entrance to Meckel's cave. Right: Radiograph showing an improperly placed balloon. The “pear” shape was not assumed in this rather large cave and the procedure had to be repeated a few days later. The needle was withdrawn out of the foramen after the balloon was placed.

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    Radiographs showing migration of the balloon into the posterior fossa. Upper Left: There is irregular distension of balloon in the scarred cave, which had been subjected to previous alcohol injections. Upper Right: The catheter was withdrawn back into the area of scarring, but distension of the balloon caused it to migrate out of the skull. Lower: The catheter was replaced within the scarred ganglion, but distension of the balloon caused it to migrate into the posterior fossa.

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