title: Percutaneous retrogasserian balloon compression for trigeminal neuralgia: review of critical technical details and outcomes.
abstract: OBJECTIVE
  To describe percutaneous balloon compression (PBC) of the trigeminal rootlets as treatment for trigeminal neuralgia (TN), including history, operative techniques, outcomes, side effects, and some recent findings increasing the likelihood of a positive outcome.
  
  
  METHODS
  PBC is indicated in patients with TN in whom microvascular decompression is considered less suitable. The procedure is simplified by the use of biplanar fluoroscopy, although it is usually carried out with C-arm fluoroscopy to facilitate the introduction of the needle and the visualization of the inflated catheter. In the right position, a clearly defined pear shape usually appears after injection of 0.5-0.7 mL of contrast material. The balloon is kept inflated for 1.5-3 minutes. It is crucial to obtain a pear shape because this probably is the most significant factor for obtaining good, long-lasting pain relief.
  
  
  RESULTS
  An analysis of 100 consecutive PBC procedures showed an initial success rate of 90% and a median pain-free time without medication of 28 months. Subdividing these patients into primary TN (n = 77) and TN secondary to multiple sclerosis (n = 23), the median pain-free times were 33 months and 24 months (P = 0.2), indicating that the outcome may depend on the preoperative conditions.
  
  
  CONCLUSIONS
  Complications and side effects include cardiovascular stress during the procedure, local hemorrhages in the cheek, postoperative sensory disturbance, masseter weakness, infections, and transitory diplopia after surgery. Measures to minimize side effects are proposed. With meticulous technique, PBC is a straightforward, effective, and fast procedure that compares well with other percutaneous therapies for TN.
authors.affiliation: Department of Neurosurgery, Umeå University Hospital, Umeå, Sweden. tommy.bergenheim@neuro.umu.se
authors.forename: A Tommy
authors.initials: AT
authors.lastname: Bergenheim
authors.forename: Pär
authors.initials: P
authors.lastname: Asplund
authors.forename: Bengt
authors.initials: B
authors.lastname: Linderoth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063125:Balloon Embolectomy / Q000295:instrumentation*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D018579:Patient Selection; D011859:Radiography; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*