Percutaneous balloon compression of Gasserian ganglion for idiopathic trigeminal neuralgia

Abstract

Objective: The aim of this study was to evaluate the outcome and complication in patients with idiopathic trigeminal neuralgia (TN) posted for percutaneous balloon compression (PBC). Materials and Methods: The study included twenty patients of idiopathic TN presented in the outpatient department of pain clinic posted for PBC from the years 2016 to 2018. All patients were followed up for 6 months after the balloon compression of Gasserian ganglion. Out of the twenty patients, 40% were female and 60% were male. The mean age was 55.4 years (range: 37–70 years). These patients were on antineuropathic (carbamazepine, baclofen, and gabapentin) drugs with inadequate pain relief and 13 patients also had undergone radiofrequency ablation. PBC of Gasserian ganglion was planned by the technique described by Mullan and Lichtor in all patients. Visual Analog Score (VAS) and Barrow Neurological Intensity (BNI) score were compared pre and post procedure. Intraoperative and postoperative complications and side effects were analyzed retrospectively. Results: Eighteen out of twenty patients (90%) had excellent results with improvement in the VAS and BNI scores, which was statistically significant. The difference between the mean change in VAS and BNI scores for single nerve and multiple nerve roots was not statistically significant. Nearly 85% (17) of the patients had initial facial numbness, which improved in about 3 months. Only 10% of the patients had residual facial numbness, which was mild in nature and not bothersome to the patients. Masseter muscle weakness was present in seven (35%) patients. No patient reported corneal anesthesia or any other complications. Intraoperatively, four patients (20%) experienced moderate-to-severe bradycardia during entry to the foramen ovale and on inflation of the Fogarty balloon, which responded to injection atropine 0.6 mg intravenously stat. Conclusion: Hereby, we state that PBC is an effective and safe method with marked improvement in pain scores and improvement in quality of life of patients of idiopathic TN.