Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia

Abstract

The authors report 144 cases of trigeminal neuralgia treated by percutaneous microcompression of the trigeminal ganglion (PMTG). The operation was performed under short-lasting barbiturate anesthesia without endotracheal intubation. Meckel's cave was cannulated with a No. 4 Fogarty catheter and the balloon was inflated for 1 minute. The average intraluminal pressure required for adequate compression of the ganglion was about 1200 mm Hg. All patients were initially relieved of their neuralgia. In a follow-up period ranging from 6 months to 4 1/2 years, 14 patients (9.7%) developed recurrence of pain between 10 and 35 months after surgery. Eleven patients underwent a second PMTG. All nine early failures and 10 of the 11 late recurrences occurred in cases with technical deficiencies. Most of the minor surgical complications observed were also related to avoidable technical errors. There were no anesthetic complications and no deaths. All patients developed mild to moderate postoperative hemifacial numbness with or without objective hypesthesia. Both subjective and objective deficits gradually diminished with time and were well tolerated. One year after the operation nearly 40% of the patients still had patches of slightly decreased sensation in one or more trigeminal divisions and 16% had mild dysesthesia. Anesthesia dolorosa or keratitis was not reported. The PMTG procedure is easy to perform and requires a short operative time and a brief period of hospitalization. It is well tolerated by patients, who describe it as a totally pain-free experience. Morbidity is minimal and recurrence of neuralgia does not seem to be higher than with alternative procedures.

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

“…This recurrence rate (20%) indicates recurrence within up to 36 months and is in accordance with other series in the literature 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . It is necessary to emphasize that, in longer follow-up periods, the recurrence rate usually becomes gradually higher.…”

“…About 33 (84.5%) of the patients had mild to moderate postoperative hemifacial numbness (hypoesthesia) that gradually diminished with time and was well tolerated. This transient hypoesthesia usually can be considered as a side effect of PBC 10,23 . However, four patients had permanent hypoesthesia and, in these cases, hypoesthesia is considered to be a complication.…”

“…However the exact cause of TN remains unclear. When TN occurs in a young patient or when it is bilateral, the presence of demyelinating conditions such as multiple sclerosis should be investigated 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . The goal of PBC is to injure the myelinated fibers that mediate the "trigger" for the lancinating pain of trigeminal neuralgia.…”

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

“…Transient additional cranial nerve deficits, presumably related to overcompression, have been reported in 1.5% of patients. 7,16,17 In our study, dysesthesias occurred in 4% and mild masseter weakness in 24% of patients. No moderate or severe numbness was produced and there were no other cranial nerve deficits.…”

“…For example, pressure measurements between 980 and 2080 mm Hg have been described. 16 One group used a compression time of 3.5 minutes and found that a low pressure resulted in a higher recurrence rate (75%) but fewer side effects (0%), whereas with a high pressure there were no recurrences at the 1-year follow-up review, but 100% of the patients had side effects. 29 Studies have also been conducted to find the most appropriate pressure.…”