Hybrid fluoroscopy-neuronavigation technique for percutaneous balloon compression in trigeminal neuralgia: how I do it.

Percutaneous balloon compression is an established treatment for trigeminal neuralgia, especially in patients refractory to medical therapy or unfit for open surgery. Cannulation of the foramen ovale can be challenging due to anatomical variations. This article describes a hybrid technique combining fluoroscopy and electromagnetic neuronavigation to improve accuracy and safety. Preoperative CT planning allows individualized trajectory design, while intraoperative dual guidance minimizes multiple passes. Balloon compression is performed for 1-3 min to balance efficacy and complications. This minimally invasive procedure is effective, repeatable, and particularly suitable for elderly or comorbid patients, with a short learning curve for junior surgeons.