Outcomes of Treatment for Elderly Patients With Trigeminal Neuralgia: Percutaneous Balloon Compression Versus Microvascular Decompression

Abstract

Objective: The study aimed to evaluate the surgical outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of elderly patients with trigeminal neuralgia (TN). Methods: A total of 30 patients who underwent PBC surgery (PBC group) and 30 patients who received MVD surgery (MVD group) were included. The treatment efficacy, Barrow Neurological Institute (BNI) pain intensity score, inflammatory response, the rates of complication and recurrence were analyzed respectively. Results: The total efficacy was 93.33% in the PBC group and 90.00% in the MVD group (P > 0.05), respectively. The pain relief rate was 90.00% and 86.67% after PBC and MVD surgery, respectively (P > 0.05). The levels of IL-1β, TNF-α, and IL-6 were significantly decreased at post-operative 3 days and 5 days compared with pre-operation in the 2 groups (P < 0.05). The post-operative complication rates regarding masticatory muscle weakness and facial numbness in the PBC group were higher than MVD group (P < 0.05). Nevertheless, the incidences of herpes simplex and keratohelcosis were similar between the 2 groups (P > 0.05). The recurrence rates were also similar between the 3 groups (P > 0.05). Conclusion: Percutaneous balloon compression and MVD are effective in the treatment for elderly TN, which can effectively improve the post-operative cure rate of pain prognosis and reduce the inflammatory response. However, PBC is a minimally invasive, safe and effective method for patients in poor general condition and refused treatment with craniotomy.

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

“…Although a sizable body of studies demonstrated the importance of objective clinical predictors of curative effect, the selection of TN patients for PBC was still subjective [24,21,18]. Until now, there was no objective scale established for the prediction of TN patients' after PBC.…”

“…Although the microvascular decompression (MVD) has been widely accepted as an effective remedy for treatment of TN, it needs open-brain surgery and the mortality has been quoted as 0.22-2% [27,11,8,23]. Percutaneous balloon compression (PBC) of a trigeminal ganglion (TG) is an acknowledged alternative with a relatively high pain relief rate, ranging from 70% to over 90% [25,21,18]. Because of its convenience and safety, PBC has become a more popular remedy for trigeminal neuralgia recently.…”

Efficacy and safety of microvascular decompression versus percutaneous balloon compression in the treatment of trigeminal neuralgia: a systematic review and meta-analysis

“…Sixteen studies (13,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) compared the adverse reaction rates between MVD and PBC cases. The heterogeneity results were I 2 =64% (P=0.0003); thus, the rate of adverse reaction for PBC versus MVD treatment was 17.79 (95% CI: 10.17-31.11; P<0.00001) using the random-effects model.…”

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

“…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 ].…”