scholarly journals Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

2021 ◽  
Vol 79 (1) ◽  
pp. 51-55
Author(s):  
Jennyfer Paulla Galdino CHAVES ◽  
Tatiana Von Hertwig Fernandes DE OLIVEIRA ◽  
Alexandre Novick FRANCISCO ◽  
Mariana de Oliveira TRINTINALHA ◽  
Niels Vinicius Pádua CARVALHO
Keyword(s):  
Retrospective Study ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Microvascular Decompression ◽  
Recurrence Time ◽  
Type I ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression

ABSTRACT Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.

scholarly journals Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia

Neurosurgery ◽  
2015 ◽  
Vol 78 (3) ◽  
pp. 421-428 ◽  
Author(s):  
Pär Asplund ◽  
Patric Blomstedt ◽  
A. Tommy Bergenheim
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Percutaneous Treatment ◽  
Primary Treatment ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Sensory Disturbances ◽  
Glycerol Rhizolysis

Abstract BACKGROUND: Despite >30 years of clinical use, the literature is still sparse when it comes to comparisons between percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizolysis (PRGR) as treatments for trigeminal neuralgia. OBJECTIVE: To perform a retrospective cohort comparison between PBC and PRGR with regard to therapeutic effect, side effects, and complications. METHODS: Medical records and follow-up data from 124 primary PRGRs performed from 1986 to 2000 and 82 primary PBCs performed from 2000 to 2013 were reviewed. All patients had undergone clinical sensory testing and assessment of sensory thresholds. Analyses were performed to compare duration of pain relief, frequency of sensory disturbances, and side effects. RESULTS: Median duration of pain relief was 21 months after PRGR and 20 months after PBC. Both methods carried a high risk of hypesthesia/hypalgesia (P < .001) that was partly reversed with time. Decreased corneal sensibility was common after PRGR (P < .001) but not after PBC. Dysesthesia was more common after PRGR (23%) compared after PBC (4%; P < .001). Other side effects were noted but uncommon. CONCLUSION: PBC and PRGR are both effective as primary surgical treatment of trigeminal neuralgia. Both carry a risk of postoperative hypesthesia, but in this series, the side effect profile favored PBC. Furthermore, PBC is technically less challenging, whereas PRGR requires fewer resources. Between these 2 techniques, we propose PBC as the primary surgical technique for percutaneous treatment of trigeminal neuralgia on the basis of its lower incidence of dysesthesia, corneal hypesthesia, and technical failures.

Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia

2010 ◽  
Vol 113 (3) ◽  
pp. 486-492 ◽  
Author(s):  
Konstantinos Kouzounias ◽  
Göran Lind ◽  
Gastón Schechtmann ◽  
Jaleh Winter ◽  
Bengt Linderoth
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Modalities ◽  
Recurrence Time ◽  
Chi Square ◽  
Balloon Compression ◽  
Duration Of Effect ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Chi Square Test

Object The aim of this study was to compare percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) in terms of effectiveness, complications, and technical aspects. Methods Sixty-six consecutive PBC procedures were performed in 45 patients between January 2004 and December 2008, and 120 PRGR attempts were performed in 101 patients between January 2006 and December 2008. The PRGR procedures were not completed due to technical reasons in 19 cases. Five patients in the Balloon Compression Group and 9 patients in the Glycerol Group were lost to follow-up and were excluded from the study. The medical records and the intraoperative fluoroscopic images from the remaining cases were retrospectively examined, and the follow-up was completed with telephone contact, when necessary. The 2 groups were compared in terms of initial effect, duration of effect, and rates of complications as well as severity and type of complications. Results The rates for immediate pain relief were 87% for patients treated with glycerol injection and 85% for patients treated with balloon compression. The Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence time was 21 months for the balloon procedure and 16 months for the glycerol procedure. When the groups were broken down by the “previous operations” criterion, the 50% recurrence time was 24 months for the Glycerol First Procedure Group, 6 months for the Balloon First Procedure Group, 8 months for the Glycerol Previous Procedures Group, and 21 months for the Balloon Previous Procedures Group. The rates of complications (excluding numbness) were 11% for PRGR and 23% for PBC, and this difference was statistically significant (chi-square test, p = 0.04). Conclusions Both PRGR and PBC are effective techniques for the treatment of trigeminal neuralgia, with PRGR presenting some advantages in terms of milder and fewer complications and allowing lighter anesthesia without compromise of analgesia. For these reasons the authors consider PRGR as the first option for the treatment of trigeminal neuralgia in patients who are not suitable candidates or are not willing to undergo microvascular decompression, while PBC is reserved for patients in whom the effect of PRGR has proven to be short or difficult to repeat due to cisternal fibrosis.

Percutaneous balloon compression of the trigeminal nerve for treatment of trigeminal neuralgia

1996 ◽  
Vol 1 (2) ◽  
pp. E10 ◽  
Author(s):  
Jeffrey A. Brown ◽  
Christopher J. Chittum ◽  
David Sabol ◽  
Jan J. Gouda
Keyword(s):  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Survival Curve ◽  
Balloon Catheter ◽  
Computer Hardware ◽  
Myelinated Fibers ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Corneal Reflex

The technique of percutaneous balloon compression for treatment of trigeminal neuralgia is demonstrated by using embedded audiovisual kernels. A text-based description with linked images is also provided to accomodate varying computer hardware capabilities. A new needle system for guiding the balloon catheter to the entrance of Meckel's cave and a balloon pressure monitoring system for the procedure is described and demonstrated. Results from a series of 141 consecutive patients treated during the period between 1983 and 1995 indicate an initial success rate of 92%. Fifty-seven percent of patients have postoperative numbness, which is described as mild to moderate by 94% of them. Sixteen percent have ipsilateral masseter-pterygoid weakness after compression. The overall recurrence rate is 26%. A Kaplan-Meier survival curve indicates that 60% of patients are pain free 8 years after surgery without recurrence requiring reoperation. The recurrence rate does not significantly differ from patients with first division pain to patients without first division involvement. An absent corneal reflex has not occurred, nor has anesthesia dolorosa. Balloon compression injures the myelinated fibers that mediate the “trigger” to the lancinating pain of trigeminal neuralgia. Because the corneal reflex is mediated by unmyelinated fibers, selective, monitored compression of myelinated fibers should preserve the corneal reflex when first division pain is present.

Clinical Effect of Partial Sensory Root Rhizotomy on Recurrence of Multiple Sclerosing Trigeminal Neuralgia After Percutaneous Balloon Compression

2021 ◽  
Author(s):  
Yuanchao Li ◽  
Guodong Zhang ◽  
Jiaqi Zhang ◽  
Zhenguo Cheng ◽  
Yanping Lan
Keyword(s):  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Clinical Effect ◽  
Effective Rate ◽  
Cerebrospinal Fluid Leakage ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Difference ◽  
Sensory Root

Abstract Objective To investigate the Clinical effect of partial sensory root rhizotomy(PSR) on recurrence of multiple sclerosing trigeminal neuralgia(TN-MS) after percutaneous balloon compression(PBC). Methods A retrospective analysis of the clinical data of 21 cases of recurrent multiple sclerosis trigeminal neuralgia after PBC who were treated with PSR in the Department of Neurosurgery of Xinxiang Central Hospital from January 2012 to July 2018; The diagnosis of MS was made by McDonald criteria, and using MRI to exclude REZ Regional blood vessels compress nerves; analysis of patients' preoperative and postoperative Visual Analogue Score (VAS), VAS 0-3 points means effective, 4 points and above means invalid or recurrence.Results Preoperative VAS: 8 -10 points in 21 cases, 1 day and 6 months after surgery VAS: 0-3 points in 21 cases, effective rate 100%; 12 months after surgery: 4 points in 2case, effective rate 95%, recurrence rate 5%; 18 months after surgery, 4 cases scored above 4, the effective rate was 81%, and the recurrence rate was 19%. The average point of VAS after PSR at 1 day, 6M, 12M, and 18M were lower than PBC, P<0.05, and the difference was statistically significant. The postoperative recurrence rate of PSR at 6M, 12M, and 18M is lower than that of PBC, P<0.05, and the difference is statistically significant. All 21 patients had facial sensation loss after surgery without major complications such as intracranial hemorrhage, facial palsy, and cerebrospinal fluid leakage. 1 case of intracranial infection. Conclusion PSR is effective in the treatment of TN-MS and can be used as a treatment for recurrence after PBC.

scholarly journals Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring

2005 ◽  
Vol 18 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Jeffrey A. Brown ◽  
Julie G. Pilitsis
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Masseter Muscle ◽  
Intraluminal Pressure ◽  
Pressure Monitoring ◽  
Compression Pressure ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Mean

Object Percutaneous balloon compression is an effective and technically simple method for treating trigeminal neuralgia (TN). Nevertheless, dysesthesias (10–20%) and masseter muscle weakness (66%) following the procedure have been noted. The purpose of this study was to evaluate the results of testing TN with percutaneousballoon compression aided by intraluminal pressure monitoring. Methods In this study the authors review the results and complications associated with percutaneous balloon compression by using intraluminal pressure monitoring data obtained in 65 procedures performed in 56 consecutive patients over 4 years. The mean patient age was 71 years (range 37–92 years), and the mean follow-up duration was 17 months (range 3–38 months). The mean intraluminal compression pressure was (1160 ± 62 mm Hg), and the mean duration of compression was 1.15 ± 0.27 minutes. The trigeminal depressor response was observed in 60 (92%) of 65 procedures, and initial pain relief occurred in 92% of patients. The recurrence rate in patients who had initial relief was 16% (nine of 56). The mean time until recurrence in patients who experienced pain relief after surgery was 13 months (range 3–23 months). Mild numbness immediately after surgery was observed in 83% of patients. At the most recent evaluation, 17% of patients reported persistent, nontroublesome numbness and none had moderate or severe numbness. Minor dysesthesia was present in two patients (4%). Mild masseter muscle weakness occurred in 24% of patients and resolved within a maximum period of 1 year. No patient experienced anesthesia dolorosa, corneal keratitis, or other cranial nerve deficits. These morbidity rates are lower than the incidence reported in the literature when pressure monitoring is not used. Conclusions These data show that by monitoring compression pressure and limiting the duration of compression, it is possible to reduce the incidence of dysesthesias, severe numbness, and masseter weakness after surgery without increasing the rate of recurrent pain in patients with classic TN.

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

2010 ◽  
Vol 113 (3) ◽  
pp. 498-507 ◽  
Author(s):  
Pär Asplund ◽  
Bengt Linderoth ◽  
A. Tommy Bergenheim
Keyword(s):  
Electrical Stimulation ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Therapeutic Effect ◽  
Sensory Function ◽  
Careful Study ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Impact

Object 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. Methods 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. Results 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. Conclusions 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.

206 Percutaneous Balloon Compression as Treatment to Trigeminal Neuralgia: 14 Years of Experience in a Single Center

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 256-256
Author(s):  
Nilson Nogueira Mendes Neto ◽  
Jessika Thais da Silva Maia ◽  
Daniel Duarte Rolim ◽  
Marcelo Rodrigues Zacarkim ◽  
Juliano Jose da Silva ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Positive Influence ◽  
Functional Neurosurgery ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Safe Technique ◽  
Relief Rate

Abstract INTRODUCTION Percutaneous balloon compression of the Gasserian ganglionic has been used to treat Trigeminal Neuralgia (TN) since 1983. METHODS We performed a retrospective study on 222 patient's records which have received 242 procedures of Percutaneous Balloon Compression (PBC) as treatment for TN. A 6 months follow-up period after surgery was needed to be included in the study. They were operated at Functional Neurosurgery Unit in Brazil from February 2002 to July 2016. RESULTS >The patient's age ranged from 29 to 91 years (mean, 62, 2 years), 43% were males and 57% were females. Rare cases of bilateral trigeminal neuralgia were seen in 5 patients. Immediately after surgery, 193 (79,7%) patients became pain-free and 34 (14%) patients became pain free during the following 4 days. Carbamazepine was suspended in 93.7% of cases. Out of the total, only 13 (5,37%) patients related residual pain on follow-up. Hypoesthesia was reported after 83,8% of procedures. In addition, bradycardia was seen in 58,1% of cases during foramen ovale puncture. Transitory complications such as diplopia (2,47%), otalgia (1,23%) and tinnitus (1,23%) were reported. Regarding to balloon appearance, pear and dumb-bell shapes were detected in 74,8% and 7,4% of procedures, respectively. Only 15 (6,19%) patients needed a reoperation due to pain persistence. CONCLUSION PBC showed to be an effective and safe technique which provides high rates of pain relief (93,7%) in the following 6 months after surgery. The Carbamazepine's use was markedly reduced (93,7%). In addition, relapse of pain occurred in few cases (5,37%). Complications were minor and transitory. Comparing statistically, we can stat that the balloon shapes (82,2%) and hypoesthesia (83,8%) findings had a positive influence on pain relief rate (93,7%). Our findings support that PBC should be considered as primary surgical treatment of trigeminal neuralgia.

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