Percutaneous balloon rhizotomy for trigeminal neuralgia using three-dimensional fluoroscopy

Background: Percutaneous balloon rhizotomy is one of the standard techniques for the treatment of trigeminal neuralgia. However, there have been well-reported complications from cannulating the foramen ovale (FO). We describe a novel technique for cannulating the FO using 3-dimensional (3D) rotational fluoroscopy. Methods: Three-dimensional rotational fluoroscopy is used to reconstruct the skull base. The optimal working projection is thus generated to best visualize the FO. When the optimal working projection is not anatomically feasible, for example, in a patient with severe cervical spondylosis, further rotational fluoroscopic data acquisition can assess the position of the needle to determine its relationship to the foramen. Furthermore, while inflated, the balloon position can also be verified with the same rotational technique. Results: Three-dimensional rotational fluoroscopy allows quick, safe, and easy cannulation of the FO. The equipment is readily available in the biplanar fluoroscopy suite. Its use should decrease the incidence of complications reported with the standard fluoroscopic technique. Conclusions: Three-dimensional rotational fluoroscopy allows real-time visual guidance to cannulate the FO and determine the optimal position of the inflated balloon. We believe that this is an important adjunct for treating trigeminal neuralgia via percutaneous techniques.