• Yuchen Tian, Yanmeng Tan, Wei Gao, Lin Yang, Wei Zhang, and Xinghua Jiang.
• Department of Pain Management and Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hu'nan, People's Republic of China.
• Pain Physician. 2024 Nov 1; 27 (8): E891E898E891-E898.

BackgroundThe Hartel anterior approach is a commonly used puncture method in percutaneous balloon compression (PBC) surgery. However, anatomical variations along the puncture path, and visual errors on x-ray 2-dimensional imaging, may increase the difficulty of a successful first attempt. Our clinical practice has shown that employing the quadrant localization technique to plan puncture points and angles can enhance the puncture success rate.ObjectivesWe will demonstrate that the quadrant localization technique increases the success rate of the first puncture of the foramen ovale and the initial placement of the balloon catheter, thereby improving the efficiency of PBC surgery.Study DesignRetrospective study.SettingA single center, tertiary general hospital.MethodsThis study included a total of 371 patients with classic trigeminal neuralgia who underwent PBC surgery from January 2019 through May 2023. All patients received general anesthesia and underwent PBC surgery under radiographic guidance. In total, 170 patients underwent a puncture using the quadrant localization technique (Group Q), and 201 underwent a puncture using the conventional Hartel anterior approach (Group P).ResultsGroup Q demonstrated higher success rates for the first puncture and insertion of the balloon catheter, along with a lower total radiographic radiation dose, shorter surgical duration, and shorter hospital stay (P < 0.05). However, there were no significant differences in PBC success rates or the incidence of puncture-related side effects and complications between the 2 groups (P > 0.05).LimitationsThis study lacked information on long-term complications and pain recurrence rates. Also, single-center results may be influenced by institution-specific practices and physician-related biases.ConclusionIn PBC surgery, the quadrant localization technique improves efficiency and reduces hospital stay compared with the conventional Hartel anterior approach, without increasing the risk of complications.

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