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J Neurosurg. 2019 May 10:1-4. doi: 10.3171/2019.2.JNS182896. [Epub ahead of print]

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

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1Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University, Indianapolis, Indiana; and.
2Department of Neurosurgery, University of Kansas, Kansas City, Kansas.


OBJECTIVETrigeminal 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.METHODSThe 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.RESULTSThe 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.CONCLUSIONSPercutaneous 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.


EVD = external ventricular drain; balloon compression; pain; percutaneous rhizotomy; surgical technique; trigeminal neuralgia


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