The Focus and New Progress of Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia

Abstract

Trigeminal neuralgia is a condition confined to the trigeminal nerve, causing one or more branches of facial nerve pain. Surgical treatment options for trigeminal neuralgia include microvascular decompression(MVD), percutaneous balloon compression (PBC), radiofrequency thermocoagulation(RF), percutaneous retrogasserian glycerol rhizotomy(PRGR), gamma knife, etc. Of these treatments, PBC is increasingly being used by clinicians for trigeminal neuralgia. PBC is a simple surgical operation performed to treat trigeminal neuralgia. Owing to its advantages, PBC is favored by many clinicians. In this study, we aimed to emphasize the need to analyze the shape of the balloon, position, compression time, and pressure, as these factors can affect the efficacy of PBC. The relief of pain by balloon compression is related to the shape of the balloon on X-ray, which is the key to the operation. Owing to continued progress and advances in current imaging technologies, clinicians revealed that the precise positioning of the foramen ovale is no longer an intraoperative problem. Instead, the anatomy of Meckel's cave and the shape of the balloon must be the focus to achieve the best treatment effect. For clinicians, PBC is simple and is associated with a short operation time. PBC also has other advantages, such as low cost and immediate postoperative pain relief. The recurrence rate of pain post-PBC is low, despite the occurrence of facial numbness post-op. However, this side effect is reversible and does not affect daily life of the patient. In fact, the patient can be discharged 1-2 days after surgery. Overall, PBC can be considered as one of the preferred surgical methods for the treatment of primary trigeminal neuralgia. In this paper, we explain the main points of PBC operation in detail in terms of Meckel's cave, surgical procedure, complications, discussion of the focus and new progress, etc.

Analysis of the Correlation between Percutaneous Balloon Compression Treatment Frequency and Facial Numbness in Trigeminal Neuralgia

“…The most common complication after PBC is facial numbness, which is directly related to the success of the surgery and is an important indicator of su cient compression. Longer compression times are more effective for recurrent or refractory TN, but studies have not found that compression lasting longer than 5 minutes provides better pain relief, although facial numbness lasts longer [4]. Many scholars have analyzed the relationship between balloon compression time and postoperative facial numbness.…”

Mental Nerve Neurectomy: A Comparison of Titanium Screw Versus Gutta-Percha Oburation of the Mental Foramen

“…Moreover, it carries complications like local tissue toxicity, burning alcohol neuritis, and fibrosis in the region. Other treatment modalities include microvascular decompression, balloon decompression [ 22 ], gamma knife surgery, or the Jannetta procedure. However, these are considered highly invasive, and patients are often reluctant to choose any of these options.…”

Frame navigation guided percutaneous balloon compression for intractable trigeminal neuralgia secondary to multiple sclerosis

“…CT-guided percutaneous rhizotomy or neuro-navigation systems may facilitate needle placement and reduce the risk of complications in such cases ( Pérez-Bovet et al, 2022 ). Having an adequate anatomical localization is crucial during the procedure, as the puncture of unwanted neuro-vascular structures can result in various complications such as cranial nerve palsy, cerebrospinal fluid leak, bradycardia, carotid-cavernous fistula, intracranial hemorrhage, and others ( Xia et al, 2022 ) Meuwly et al, 2015 . The knowledge of the neuroanatomy and relationship of the foramen ovale is mandatory in avoiding these complications.…”