Carlotta Ranalli

Percutaneous balloon compression is an established treatment of medically refractory trigeminal neuralgia and remains a commonly performed percutaneous procedure for patients requiring immediate pain relief. Historically, the procedure was standardized through dedicated commercial instrument kits designed for trigeminal balloon rhizotomy, facilitating technical reproducibility across centers. However, the withdrawal of the Food and Drug Administration-approved Mullan percutaneous trigeminal ganglion microcompression set from the medical supplies market in 2016 created a supply gap that required surgeons to adapt their procedural workflows to alternative instrumentation. In the absence of dedicated commercial kits, multiple technical adaptations have emerged, resulting in heterogeneity in technical execution across centers. Contemporary practice has shifted toward modular configurations assembled from widely available instruments, often combined with adjunctive imaging technologies. These adaptations aim to preserve procedural reproducibility while maintaining accessibility across different practice settings. However, considerable variability persists, with approaches ranging from proprietary bundled systems to modular and technology-assisted workflows. Despite this variability, most contemporary series describe a broadly consistent technical approach consisting of a 3 to 5 Fr Fogarty balloon catheter introduced through a 13 to 16 gauge percutaneous needle using the classical Hartel approach under fluoroscopic guidance. Within this framework, recent refinements in foramen ovale localization, including the “H-figure” fluoroscopic landmark, may further improve procedural efficiency and reduce radiation exposure. Balloon inflation is typically performed using volume-based techniques with fluoroscopic confirmation of the characteristic pear-shaped balloon configuration within Meckel's cave, whereas quantitative pressure monitoring is infrequently reported and limited to isolated cases. This narrative review aimed to characterize current percutaneous balloon compression practice in the postcommercial kit era and to determine whether a reproducible procedural framework has emerged despite the absence of dedicated, standardized kits.

BACKGROUND Virtual reality (VR) and three-dimensional (3D) visualization technologies are increasingly recognized as valuable tools in surgical fields, especially where spatial understanding is critical. In pediatric neuro-oncology, these tools may address specific challenges related to anatomical complexity, child-specific anatomy and the need for precision in tumor resection. OBJECTIVE To evaluate the use of VR, 3D and immersive visualization technologies in pediatric brain tumor surgery, focusing on their role in surgical planning and clinical relevance. METHODS A systematic review was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD420261279242). Literature searches were performed across PubMed, Embase, Scopus, and Web of Science up to October 25, 2025. Studies were included if they reported original clinical or translational data on the use of VR, 3D, or immersive visualization technologies in pediatric brain tumor surgery or planning. RESULTS Seven studies met the inclusion criteria. VR/3D tools were mainly used for preoperative planning in high-complexity tumor cases. Reported benefits included improved spatial understanding in 86% of studies, increased planning confidence in 57%, and strong educational value in 86%. However, no study reported objective outcome measures or long-term patient data. Implementation was heterogeneous, with substantial variability in platforms and workflows. CONCLUSIONS VR and 3D technologies show promise in improving planning and spatial understanding in pediatric neuro-oncology. However, evidence is limited by heterogeneity and lack of objective and long-term outcome data, highlighting the need for standardized and robust studies.

Background: Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment for spinal cord injuries (SCIs) to mitigate a secondary injury and enhance neurological recovery. While the preclinical evidence is consistently supportive, clinical data remain heterogeneous across traumatic (TSCI) and non-traumatic (NTSCI) etiologies. Methods: A hybrid systematic review was conducted in accordance with the PRISMA 2020 guidelines and included an illustrative single-center clinical case. PubMed, OVID Medline, and Google Scholar were searched for studies published between 1978 and 2024. Due to methodological heterogeneity, qualitative synthesis was performed. Results: Fifty studies comprising 1102 patients were included. Neurological improvement was more frequently observed in incomplete injuries and when HBOT was initiated early. Conclusions: HBOT may represent a useful adjunct in selected SCI patients, although standardized protocols and controlled trials are required to better define its role.