Balloon compression vs radiofrequency for primary trigeminal neuralgia: a randomized, controlled trial

Abstract

Surgical procedures are necessary in up to 50% of trigeminal neuralgia patients. Although radiofrequency (RF) is more widely used, it is associated with high intraprocedural costs and long technical learning time. Other simpler procedures such as balloon compression (BC) require a lower training period and have significant lower costs. We evaluated the effects of BC and RF in pain control in primary trigeminal neuralgia in a randomized, double-blinded, head-to-head trial. Individuals were randomly allocated in 1 of 2 groups: BC and RF. Throughout pain, psychological and quality of life measurements were performed at baseline and after surgery. The main outcome was the worst pain in the last 24 hours (0-10) at 6 months postoperatively. After the inclusion of half of the estimated sample, a preplanned interim analysis was performed when 33 patients (62.1 ± 9.4 y.) completed the study. Pain intensity (confidence interval [CI] 95% 0.6 to 3.8, and −0.6 to 2.2, for BC and RF) did not significantly differ. Complications, interference of pain in daily life (CI 95% −0.1 to 2.3 and −0.4 to 2.3, for BC and RF), neuropathic pain symptoms (CI 95% 1.7 to 3.6 and 3.0 to 5.7, for BC and RF), mood (CI 95% 4.8 to 11.5 and 5.5 to 15.1, BC and RF, respectively), medication use, and quality of life (CI 95% 80.4 to 93.1 and 83.9 to 94.2, for BC and RF) were also not different. Radiofrequency presented more paresthetic symptoms than BC at 30 days after intervention. Based on these results, the study was halted due to futility because BC was not superior to RF.

Comparison of Effectiveness and Safety between Intraoperative 3D-CT-Guided and C-Arm-Guided Percutaneous Balloon Compression for Idiopathic Trigeminal Neuralgia: A Multi-Center Retrospective Study

“…Except PBC, other microinvasive approaches, such as gamma knife radiotherapy, glycerol rhizotomy, and radiofrequency thermocoagulation, were also reported to be useful in treatment of ITN [1,[6][7][8][9]. A recently published meta-analysis concerning TN showed that glycerol rhizotomy showed similar rate of immediate pain relief and pain recurrence with PBC but showed lower incidences of numbness and diplopia, while the incidences of other complications were similar in both groups [9].…”

“…Different from other subgroups where neurovascular compression or underlying diseases can easily be identified, ITN does not show significant abnormalities in electrophysiological tests or MRI scans, which makes etiological targeted surgeries impossible [5]. Other surgeries, such as percutaneous balloon compression (PBC), gamma knife radiotherapy, glycerol rhizotomy, and radiofrequency thermocoagulation, have repeatedly been reported to be useful for pain control in TN for which pharmacological treatments have failed [1,[6][7][8][9]. Among these surgical options, PBC is a commonly used microinvasive technique and shows potential in the control of TN [6,9,10].…”

“…Other surgeries, such as percutaneous balloon compression (PBC), gamma knife radiotherapy, glycerol rhizotomy, and radiofrequency thermocoagulation, have repeatedly been reported to be useful for pain control in TN for which pharmacological treatments have failed [1,[6][7][8][9]. Among these surgical options, PBC is a commonly used microinvasive technique and shows potential in the control of TN [6,9,10]. However, PBC involves the cannulation of foramen ovale (FO) which requires clinicians to overcome a challenging learning curve and is a very important procedural component [11][12][13][14].…”

“…Among these surgical options, PBC is a commonly used microinvasive technique and shows potential in the control of TN [ 6 , 9 , 10 ]. However, PBC involves the cannulation of foramen ovale (FO) which requires clinicians to overcome a challenging learning curve and is a very important procedural component [ 11 – 14 ].…”

Flatness of the Meckel Cave May Cause Primary Trigeminal Neuralgia: a Radiomics-based Study

“…The precise acquisition of MC morphological data through the radiomics method is beneficial for the preparation of PBC for PTN. PBC requires the puncture of the MC and filling up of the balloon to compress the semilunar ganglion nerve 36 . The accurate evaluation of the MC volume before PBC can not only provide reference for the balloon filling volume, but also prepare appropriate balloon volume for some special MC volumes (the maximum volume of MC in this study was 1589.90 mm3).…”