Balloon Compression For Trigeminal Neuralgia Research Articles

A prospective cohort study on perioperative percutaneous balloon compression for trigeminal neuralgia: safety and efficacy analysis.

With the recent emergence of percutaneous balloon compression (PBC) as a promising treatment for trigeminal neuralgia (TN), there is a growing need for research on its safety and efficacy. This study was designed to evaluate the safety and efficacy of PBC in the treatment of TN patients during the perioperative period. This study involved a total of 400 TN patients who were selected and treated with PBC at our institution. The clinical data and short-term outcomes were analyzed based on sex, initial PBC treatment for TN, and subsequent PBC treatment for recurrent TN after previous PBC or microvascular decompression (MVD) or radiofrequency thermocoagulation (RFT). No statistically significant difference was found when comparing postoperative pain relief between male and female patients with TN. Nevertheless, female patients were found to be more vulnerable than male patients to abnormal facial sensations (P = 0.001), diplopia (P = 0.015), postoperative headache (P = 0.012), and hyposmia (P = 0.029). Additionally, it was observed that there was no substantial difference in the postoperative pain relief rate between the first-time PBC group and PBC for recurrent TN patients postoperatively following procedures such as PBC, MVD, and RFT. In conclusion, this study has shown that PBC treatment is effective in managing TN in both males and females, regardless of whether the treatment was administered as a primary intervention or following prior surgical procedures such as PBC, MVD, or RFT. Nonetheless, it is noted that the risk of postoperative complications appears to be higher in female patients compared to male patients.

Letter to the Editor. Modern percutaneous balloon compression for trigeminal neuralgia.

Letter to the Editor. Modern percutaneous balloon compression for trigeminal neuralgia.

Percutaneous balloon compression for trigeminal neuralgia due to the primitive trigeminal artery: A case report and review of the literature

Trigeminal neuralgia (TN) is often caused by vascular compression of the trigeminal nerve cisternal segment. TN due to the primitive trigeminal artery formed by developmental variants of cerebral vessels is rare. We report here a 59-year-old male with TN whose preoperative MRI showed a primitive trigeminal artery that compressed the trigeminal nerve, and microvascular decompression (MVD) was performed to separate the vessel from the trigeminal nerve cisternal segment. The pain was relieved after MVD, but it recurred two months later. MRI reexamination showed that although MVD relieved the vascular compression of the trigeminal nerve cisternal segment, the nerve in the Meckel’s cave was still compressed by PTA, which was thought to be the cause of TN recurrence. Due to the limitations of the surgical microscope view, completing the vascular decompression at the Meckel’s cave is challenging. So percutaneous balloon compression was performed. After the procedure, the TN subsided. The patient remained pain free at one year follow-up. To our knowledge, this is the first case of primitive trigeminal artery-associated TN treated by percutaneous balloon compression. This case suggests that percutaneous balloon compression may be considered for TN caused by compression of the primitive trigeminal artery when MVD is difficult to perform.

The Value of a Headless Pear Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia.

Percutaneous balloon compression (PBC) has been regarded as a simple and effective remedy for trigeminal neuralgia. This study aims to retrospectively analyze the correlation between intraoperative balloon shapes and postoperative outcomes. Those consecutive PBC cases performed in our department between 2019 and 2022 were reviewed. According to the intraoperative balloon figures, they were cataloged as headless pear, slim pear, bottle gourd, and winter melon groups. The degree of pain or numbness was quantified using the visual analog scale. Those pain-free or pain score <3 and satisfied by the patient were called effective, and those numb score >3 were taken into account of numbness incidence. Except for missing cases, 160 were finally recruited in this study with a mean follow-up for 23.6 ± 12.8 months. Postoperatively, the pain score plunged from 8.8 ± 1.0 to 0.8 ± 2.0 immediately, which rose slightly over time and maintained at 2.4 ± 3.1. The maximal pain score drop occurred in the headless pear group ( P < .001) and the minimal in the winter melon group ( P < .001). The early efficacy of PBC was 100%, 84.1%, 91.4%, and 50.0%, respectively. However, the long-term efficacy was 88.2%, 75.0%, 82.1% and 25.0%. The ipsilateral numbness occurred in most of the cases immediately after PBC with a score of 3.5 ± 2.3, which decreased significantly within 3 months to 2.3 ± 2.0 and turned to 1.7 ± 1.8 finally ( P < .05). The highest and lowest numb score appeared in bottle gourd and winter melon groups, respectively ( P < .05). A headless pear shape emerged in lateral fluoroscopy as the balloon was fully inflated indicates that the entire Meckel cave is suffused, and hence, the anterior semilunar ganglion has been solidly compressed, which may lead to a successful outcome.

Percutaneous balloon compression for trigeminal neuralgia: experience and surgical techniques from a single institution

ObjectiveThe treatment experience and the technical skill with percutaneous balloon compression (PBC) for treatment of primary trigeminal neuralgia (TN) were summarised in a single institution.MethodsThis is a retrospective review including consecutive patients with typical symptoms of uni-lateral primary TN who underwent PBC from June 2020 to September 2021 in our institution. We excluded secondary aetiologies of TN. Patient demographics, surgical techniques and outcomes were reviewed. All included patients were initially managed with carbamazepine before PBC.ResultsA total of 70 patients were included. The mean length of follow-up was 10.6 months. Sixty-nine (98.6%) were successfully treated, and only one patient failed due to particularly narrow foramen ovale. Amongst successfully treated patients, 68 (97.1%) had immediate pain relief, with one having delayed relief. Sixty-eight patients (97.1%) had immediate facial numbness post-operatively and one (1.4%) presented delayed numbness 7 days after surgery. In the last follow-up, regarding facial numbness, 22 (31.9%) patients had complete resolution, whilst 46 (67.6%) had different degrees of benefit. Forty-nine (71.0%) patients developed masseter muscle weakness with recovery at 3-month follow-up. No anaesthesia dolorosa, keratitis, intracranial infection or death occurred in this study.ConclusionPBC for treatment of TN has quick and effective result, and could be safely performed under general anaesthesia without discomfort to the patient. The common postoperative complications are facial numbness and masseter muscle weakness, with most being improved or recovered at follow-up.

Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences

ObjectivesThis study aims to discuss the availability of robot-assisted percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) and share our preliminary experiences.MethodsPatients with TN who underwent robot-assisted PBC from June to September 2022 were enrolled. We designed a fixing plug for robot-assisted PBC, three-dimensional structured light registration was used, puncture trajectory was the line connects the medial third of inner and outer aperture of foramen ovale. Numerical Rating Scale (NRS), Barrow Neurological Institute (BNI) pain and numbness intensity score were used to evaluate the facial pain and numbness.ResultsEventually, nine patients were enrolled, the structured light registrations were successfully finished in all patients with a mean registration error of 0.68 mm. All the punctures of foramen ovales were successfully done one-time. Of note, the balloons were all got pear-shaped followed by 150 to 180 s compression. Though, postoperatively, all the patients complained of facial numbness and four patients suffered from transient masseter weakness, all patients got fully or mostly pain relief. It should be noted that is the numbness and weakness gradually relieved during follow-up.ConclusionThree-dimensional structured light registration and robot assisted PBC is an effective choice for patients with TN. Extension line between the medial third of the inner and outer aperture of foramen ovale might be a safe and effective puncture trajectory to this procedure.

A retrospective study to examine the association of different pear-shaped balloons with efficacy and postoperative complications in percutaneous balloon compression for trigeminal neuralgia.

Percutaneous balloon compression is a safe and effective therapeutic modality for trigeminal neuralgia. It is widely recognized that the pear-shaped balloon is the key to the success of the procedure. This study aimed to analyze the effect of different pear-shaped balloons on the duration of the treatment outcome. In addition, the relationship between individual variables and the duration and severity of complications was analyzed. The clinical data and intraoperative radiographs of 132 patients with trigeminal neuralgia were reviewed. We classify pear-shaped balloons into type A, type B, and type C balloons depending on the size of their heads. The collected variables were correlated with prognosis by univariate and multivariate analyses. The efficiency of the procedure was 96.9%. There was no significant difference in pain relief rates between the different pear-shaped balloons. Median pain-free survival time was longer for type B and C balloons, which were significantly different from type A balloons. In addition, pain duration also was a risk factor for recurrence. There was no significant difference in the duration of numbness between the different types of pear-shaped balloons, but type C balloons resulted in longer-lasting masticatory muscle weakness. Duration of compression and balloon shape can also significantly influence the severity of complications. Different pear-shaped balloons have been shown to have a significant effect on the efficacy and complications of the PBC procedure, with type B balloons (head ratio: 10-20%) appearing to be the ideal pear shape. However, its clinical application remains to be validated.

Percutaneous Balloon Compression for Trigeminal Neuralgia. A Comparative Study Between the Fluoroscope Guided and Neuronavigated Technique.

Percutaneous balloon compression (PBC) is a safe and effective procedure in the treatment of trigeminal neuralgia (TN) due to its simplicity, low cost and the possibility of being repeated in case of pain recurrence. Foramen ovale (FO) cannulation is accomplished with the assistance of intraoperative C-arm fluoroscopy. Recently, several authors have reported successful application of intraoperative CT navigation as well. The reported advantages of CT navigation are linked to better spatial orientation and the low rate of attempts for FO cannulation. However, these advantages should be considered in the face of concerns regarding increased radiation dose to the patient and its possible adverse effects. Here we compared the fluoroscopic guided and neuronavigated PBC techniques in terms of efficacy and radiological exposure. We retrospectively analyzed 37 patients suffering for TN and submitted to PBC. We observed a significant improvement of pain at 1month FU compared with the pre-operative in both groups (p<0.0001 and p<0.0001, respectively). A significant increase in radiation exposure was found in the neuronavigated group compared with the fluoroscopy group (p<0.0001). We suggest the use of neuronavigated PBC only in selected cases, such as patients with multiple previous operations, in whom a difficult access can be pre-operatively hypothesized.

Percutaneous balloon compression for trigeminal neuralgia: a how I do it.

Surgical treatments for trigeminal neuralgia may include percutaneous techniques including the balloon compression technique. We present here a simple, effective, and safe adaptation of the historical technique described by Mullan in 1978. Our procedure is performed in a bi-plane neuro-radiology room. During general anesthesia, 14-G needle is guided under radioscopy to foramen ovale. The 3-F embolectomy catheter is then inserted and inflated with contrast for a period of 2min 15s. Our technique, performed entirely under bi-plane fluoroscopy, allows a quicker and more precise surgery and avoids errors in guiding the catheter that can result serious injury.

Robot-Assisted Percutaneous Balloon Compression for Trigeminal Neuralgia: Technique Description and Short-Term Clinical Results.

ObjectivePercutaneous balloon compression (PBC) is a minimally invasive treatment for trigeminal neuralgia (TG) with a favorable cost-effectiveness ratio, but this technique has a steep learning curve. This study presents our initial clinical experience of robot-assisted PBC using a neurosurgical robot on six consecutive patients with TG.MethodsWe fixed the patient's head with a skull clamp and connected it with the linkage arms of a Sinovation® neurosurgical robot, which was then registered using four bone fiducials by the robotic pointer. The puncture needle was positioned at the entry point on the skin using a robotic arm and advanced to the target point after the skin had been incised with a pointed surgical blade. This procedure was repeated for a second trajectory. A balloon was then advanced and inflated using 0.3 ml of a contrast agent. Upon injection of 0.6 ml contrast agent, the ganglion was kept compressed for 120 s. After removal of the balloon and puncture needle, compression of the face was performed to achieve hemostasis.ResultsAll patients achieved immediate pain relief following PBC. No permanent or severe complications were registered, and there was no pain recurrence in any of the patients during the follow-up period.ConclusionsDespite requiring a longer time for preoperative preparation, robot-assisted PBC provided a high degree of accuracy and safety, and it can also shorten the learning curve for surgeons unfamiliar with PBC. Robot-assisted surgical approaches should be further developed and adopted for PBC.

The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia.

BackgroundThe pear shape of an inflated balloon is thought to be a gold standard of successful percutaneous balloon compression (PBC). However, neither how nor why it changes in that way (the anatomic basis) has not yet been fully described.AimIn this article, we try to describe how the balloon in Meckel’s cave (MC) should appear and why; and identify which shapes are good pear shapes, which shapes are not good pear shapes, and which shapes are intermediate.MethodsRadiographs from over 150 percutaneous balloon compression (PBC) cases were thoroughly evaluated. We proposed a model of changing balloon shape in MC and 70 cases were followed up over two years, in which therapeutic effect was measured.ResultsWe found that the balloon changed stereotypically in MC. The model that we proposed is consistent with the description of MC’s structures and its’ surroundings in the literature. The distinct pear (pear in MC) brought about a far better surgical result than other shapes (p < 0.01).ConclusionOur study showed how and why the balloon shape changed during PBC surgery. The model provides clear guidance for PBC surgery.

Correlation of preoperative reconstruction of foramen ovale parameters and intraluminal balloon pressure during percutaneous balloon compression for trigeminal neuralgia

Objective: To explore the relationship between the anatomic parameters of foramen ovale and intraluminal pressure during percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia. Methods: Twenty patients diagnosed with primary trigeminal neuralgia in the Department of Pain Medicine of the Third Xiangya Hospital, Central South University between November 2020 and April 2021 were enrolled. Three-dimensional (3D) high-resolution CT reconstruction of skull base was performed preoperatively to evaluate the parameters of foramen ovale. The intraluminal balloon pressure was continuously recorded during the PBC procedure. Correlation analysis was conducted between intraluminal pressure and foramen ovale parameters. Results: Eighteen patients had complete pain relief, 1 had obvious relief, and 1 had partial relief after PBC. The maximum cross-sectional length of the foramen ovale was (7.8±1.7) mm. The peak intraluminal pressure (PM) during PBC was (194±27) kPa. The intraluminal pressure was (164±28) kPa at initial compression (P0), and (135±20) kPa after compression for 120 seconds respectively. Correlation analysis showed that the P0 was positively and significantly correlated with the length of foramen ovale (r=0.56, P<0.05), but not with the width of foramen ovale (r=0.24, P>0.05), the area of foramen ovale (r=0.36, P>0.05) and the degree of balloon filling (r=-0.09, P>0.05). Similarly, P120 was significantly correlated with the length of foramen ovale (r=0.54, P<0.05). No significant correlation was observed between P120 and the width of the foramen ovale (r=0.18, P>0.05), the area of the foramen ovale (r=0.28, P>0.05) or the width of balloon filling (r=-0.13, P>0.05). Conclusions: The length of foramen ovale correlates with the intraluminal pressure during PBC procedure in trigeminal neuralgia patients. Parameters of foramen ovale obtained via preoperative high-resolution CT reconstruction of skull base may provide reference for predicting targeted intraluminal balloon pressure during PBC.

A Prospective Study to Examine the Association of the Foramen Ovale Size with Intraluminal Pressure of Pear-Shaped Balloon in Percutaneous Balloon Compression for Trigeminal Neuralgia.

IntroductionPercutaneous balloon compression (PBC) is an effective and safe option for patients with trigeminal neuralgia. A pear-shaped balloon can be used to identify the proper compression of the Gasserian ganglion during the PBC procedure. The aim of this study was to evaluate the relationship between the foramen ovale (FO) size and intraluminal pressure of the pear-shaped balloon.MethodsThirteen patients that presented with classical trigeminal neuralgia were scheduled to undertake PBC surgery at the Pain Department of the Third Xiangya Hospital, Central South University, from November 2020 to April 2021. Three-dimensional computed tomography reconstruction of the skull base was performed to capture the feature of FO preoperatively. The intraluminal pressure was continuously recorded when a pear-shaped balloon was obtained during the procedure. Correlation analysis was calculated to determine the association of the intraluminal balloon pressure with FO parameter.ResultsAll participants reported complete relief of pain at discharge. The enduring analgesic effect of PBC was maintained in all patients with a median follow-up up to 5.5 months (range, 3–8 months). The average intraluminal balloon pressure was 161.5 ± 29.4 kPa at the initial compression (P1), and 134.8 ± 21.5 kPa at the ending of compression (P2), respectively. P1 was significantly correlated with the length (r = 0.61, P = 0.024) of FO. Similarly, a significant and positive correlation was observed between P2 and the length (r = 0.63, P = 0.022) of FO.ConclusionsPreoperative assessment of FO may be a potential predictor of intraluminal pressure to reach a pear-shaped balloon during PBC treatment. Narrow FO is associated lower intraluminal balloon pressure.

Efficacy of and risk factors for percutaneous balloon compression for trigeminal neuralgia in elderly patients

Objective To investigate the efficacy and safety of percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia in elderly patients. Methods: We retrospectively analysed data of 105 elderly patients with primary trigeminal neuralgia who were over 70 years and underwent percutaneous balloon compression using anatomic positioning and imaging guidance from January 2019 to November 2019. Results: The immediate cure rate of pain in this group of patients was 97.1% (Barrow Neurological Institute (BNI) pain scores: class I and II; numbness score: class II). Postoperative keratitis was reported in 1 patient, masticatory muscle weakness and muscle atrophy in 1 patient, herpes labialis in 8 patients and lacunar infarction in 2 patients. Facial numbness and decreased sensation occurred in patients with significant pain relief. No serious complications were reported. There was no statistically significant difference in efficacy between the short compression and long compression time groups. Conclusion: PBC is a safe and effective approach to treat trigeminal neuralgia.

Long-term outcome of percutaneous balloon compression for trigeminal neuralgia patients elder than 80 years: A STROBE-compliant article.

This article evaluates the long-term outcome of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) patients elder than 80 years. A total of 138 elderly patients aged above 80 years with primary TN, who were admitted to Neurosurgery Department, Hangzhou First People's Hospital from January 2007 to December 2011 for PBC treatment, were retrospectively analyzed in this study. The postoperative cure rate of immediate pain was 98.6% (Barrow Neurological Institute [BNI] classes I, II); according to the follow-up, the pain cure rates at 1, 2, 3, 4, and 5 years after surgery were 93.5%, 90.4%, 84.7%, 80.4%, and 72.9%, respectively. In our group, postoperative diplopia was reported in 1 case, masticatory muscle weakness in 3 cases, and herpes labialis in 19 cases. A total of 100% of pain-cured patients exhibited facial numbness and facial hypoesthesia. No serious complications occurred in this group of patients. PBC is an effective and safe procedure for TN treatment and can be employed as the preferred regimen for elderly TN patients aged above 80 years in poorer physical condition.

Endovascular Treatment of Rare Vascular Complications of Percutaneous Balloon Compression for Trigeminal Neuralgia.

To present the clinical features and outcomes of rare vascular complications of percutaneous balloon compression (PBC) for trigeminal neuralgia. These complications were treated by the endovascular technique.In this retrospective study, 5 patients with trigeminal neuralgia were treated by PBC, who complicated vascular incidence between December 2000 and May 2011. The complications included 3 internal carotid cavernous fistulae (CCF) and 2 external carotid artery system fistulae. These complications were treated by endovascular coil embolism and balloon occlusion techniques.Five patients (100%) had pain free after the PBC. All the complications were cured and symptoms were gradually improved. There was no recurrence of trigeminal neuralgia or vascular complication symptoms during the follow-up period (mean 20 months, range 7-52 months).Endovascular treatment is effective and safe for the rare iatrogenic vascular complications of the PBC procedure. Neurosurgeons should be made aware of this complication. Timely diagnosis and expedient treatment should be ensured as early as possible in order to decrease further danger.

Endovascular Treatment of Rare Vascular Complications of Percutaneous Balloon Compression for Trigeminal Neuralgia.

To present the clinical features and outcomes of rare vascular complications of percutaneous balloon compression (PBC) for trigeminal neuralgia. These complications were treated by the endovascular technique. In this retrospective study, 5 patients with trigeminal neuralgia were treated by PBC, who complicated vascular incidence between December 2000 and May 2011. The complications included 3 internal carotid cavernous fistulae (CCF) and 2 external carotid artery system fistulae. These complications were treated by endovascular coil embolism and balloon occlusion techniques. Five patients (100%) had pain free after the PBC. All the complications were cured and symptoms were gradually improved. There was no recurrence of trigeminal neuralgia or vascular complication symptoms during the follow-up period (mean 20 months, range 7-52 months). Endovascular treatment is effective and safe for the rare iatrogenic vascular complications of the PBC procedure. Neurosurgeons should be made aware of this complication. Timely diagnosis and expedient treatment should be ensured as early as possible in order to decrease further danger.

175 Predictors of Outcomes After Percutaneous Balloon Compression for Trigeminal Neuralgia

175 Predictors of Outcomes After Percutaneous Balloon Compression for Trigeminal Neuralgia

The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia

Percutaneous balloon compression is a simple and effective treatment of trigeminal neuralgia. However, results between and within different series are varying. To further improve the results in terms of pain relief, the authors believe that a careful study of the surgical procedure is important. The object of this study was to analyze the impact of balloon shape, balloon position, balloon volume, and compression time on duration of the therapeutic effect following percutaneous balloon compression. Furthermore, they analyzed the sensory side effects associated with this treatment, and how these relate to surgical parameters. Medical records and intraoperative radiographs from 87 balloon compressions were reviewed, and different surgical parameters were categorized. Univariate and multivariate analyses were performed to correlate surgical parameters to pain relief. Sensory testing with a transcutaneous electrical stimulation technique and clinical examination data were reviewed to analyze changes in sensory function. The balloon shape had a significant impact on time to recurrence of pain. A pear-shaped balloon resulted in a far better surgical result than a non-pear-shaped balloon (p < 0.001). The difference between a distinct and a less distinct pear shape was not significant (p = 0.14). Statistical significance was not reached for any of the other parameters in relation to duration of therapeutic effect. A pear-shaped balloon was also significantly associated with increased thresholds for percutaneous electrical stimulation in the immediate postoperative period, but the perception thresholds were normalized at the late follow-up at 3-9 months. A similar outcome was found for clinical testing with light touch and pinprick. The authors have demonstrated that using a pear-shaped balloon when performing percutaneous balloon compression for trigeminal neuralgia results in longer pain relief than non-pear-shaped balloons. Other surgical parameters seemed less important with respect to pain relief. Balloon compression also, in many cases, results in hypesthesia.

Cardiovascular response during trigeminal ganglion compression for trigeminal neuralgia according to the use of local anesthetics

There are controversies about the use of local anesthetics during balloon compression for trigeminal neuralgia (TN) as a protective factor for cardiovascular events. The objective of this study was to investigate cardiovascular parameters (blood pressure and heart rate [HR]) of patients that underwent trigeminal balloon compression with local anesthetics compared to a control group (placebo). This is a randomized controlled study; 55 patients were randomized into two groups: study (deep sedation and trigeminal block with 0.8-mL lidocaine 2%) and control group (deep sedation and trigeminal injection of 0.8-mL saline). Blood pressure and HR were measured in five distinct moments: preoperative, during puncture for local anesthesia/placebo, during puncture with the catheter, during balloon compression, and final evaluation. Statistical analysis was performed with Pearson's chi (2) and McNemar tests and the analysis of variance for repetitive measures. The means of systolic and diastolic blood pressures (SBP and DBP, respectively) were higher in the control group when compared to the study group at the evaluation during puncture with the catheter (p < 0.001) and balloon compression (p < 0.001 and p = 0.018 for DBP and SBP, respectively). There was an increase in the HR in the control group during the procedure (p = 0.017). The use of local anesthetics during the trigeminal balloon compression for TN can have a preventive role for the risk of cardiovascular events.