1. 2024;27;E619-E626Technique of Awake Computed Tomography–guided Percutaneous Balloon Compression of the Gasserian Ganglion for Trigeminal Neuralgia
   Prospective Study
   Bing Huang, MD, Huidan Lin, MD, Ming Yao, PhD, Keyue Xie, PhD, Yong Fei, MD, and Li Zhang, MD.

BACKGROUND: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique’s curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped.

OBJECTIVES: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring.

STUDY DESIGN: Prospective clinical study.

SETTING: Department of Anesthesiology and Pain Medical Center, Jiaxing, People’s Republic of China.

METHODS: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation.

RESULTS: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient’s chief concern.

LIMITATIONS: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery.

CONCLUSIONS: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient’s chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.

KEY WORDS: Trigeminal neuralgia, computed tomography guidance, conscious sedation, percutaneous balloon compression