The Effectiveness of Percutaneous Balloon Compression, Thermocoagulation, and Glycerol Rhizolysis for Trigeminal Neuralgia in Multiple Sclerosis

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E684-E692 ◽  
Author(s):  
Imran Noorani ◽  
Amanda Lodge ◽  
Girish Vajramani ◽  
Owen Sparrow
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Independent Observer ◽  
Balloon Compression ◽  
Kaplan Meier ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
P 75 ◽  
Surgical Options ◽  
Glycerol Rhizolysis

Abstract BACKGROUND Balloon compression (BC), thermocoagulation (TC), and glycerol rhizolysis (GR) are percutaneous surgical options for trigeminal neuralgia (TN). Whether the outcomes of these procedures in multiple sclerosis -related TN (MS-TN) are as effective as in idiopathic TN (ITN) is unknown. OBJECTIVE To retrospectively compare pain relief, complications, and durability achieved by these 3 types of procedures in MS-TN and ITN. METHODS Two hundred and four patients with typical TN were treated percutaneously: 33 had MS-TN (64 procedures) and 171 had ITN (329 procedures). All were performed by 1 of 2 neurosurgeons; interviews enabled long-term data to be gathered by an independent observer. RESULTS MS-TN patients (53.1%) had Barrow Neurological Institute pain scores of I or II after a percutaneous procedure, compared with 59.3% in the ITN cohort; there was no difference in initial relief between the 2 groups overall (P = .52). There was a trend toward fewer complications in MS-TN compared with ITN (23.4% vs 33.7%, respectively; P = .058). Kaplan–Meier analysis demonstrated no difference in durability of relief in MS-TN (median 23.0 mo) compared with ITN overall (median 24.0 mo; P = .75). Subgroup analysis demonstrated longer relief from BC and TC compared with GR in MS-TN (P = .013). Multivariate analysis confirmed that although the presence of MS does not predict durability of outcome, postoperative numbness (P = .0046) and undergoing a repeat procedure (P = .037) were significant predictors. CONCLUSION BC and TC are safe and effective in MS-TN. Postoperative numbness is the strongest prognostic factor in MS-TN.

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.

The effectiveness of percutaneous balloon compression in the treatment of trigeminal neuralgia in patients with multiple sclerosis

2015 ◽  
Vol 123 (6) ◽  
pp. 1507-1511 ◽  
Author(s):  
Sean Martin ◽  
Mario Teo ◽  
Nigel Suttner
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Balloon Compression ◽  
Root Entry Zone ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Long Term Follow Up ◽  
Surgical Modality ◽  
Symptom Recurrence

OBJECT Trigeminal neuralgia (TN) is more common in multiple sclerosis (MS) patients than in the general population and among the former has an incidence of approximately 2%. The pathophysiology of TN in MS patients is believed to be caused by a demyelinating plaque at the root entry zone, and therefore procedures that cause direct nerve damage are thought to be the most effective surgical modality. The authors aimed to compare the efficacy of percutaneous balloon compression (PBC) in TN patients with and without MS. METHODS Retrospectively collected clinical data on 80 consecutive patients who underwent 144 procedures and who received PBC forTN treatment between January 2000 and January 2010 were analyzed. The cohort included 17 MS and 63 non-MS patients. RESULTS The mean age at first operation was significantly younger in the MS group compared with the non-MS group (59 years vs 72 years, respectively, p < 0.0001). After a mean follow-up of 43 months (MS group) and 25 months (non-MS group), the symptom recurrence rate following the first operation was higher in the MS group compared with that in the non-MS group (86% vs 47%, respectively, p < 0.01). During long-term follow-up, more than 70% of MS patients required multiple procedures compared with only 44% of non-MS patients. Excellent or satisfactory outcomes were not significantly different between the MS and non-MS cohorts, respectively, at 1 day postoperatively (82% vs 91%, p = 0.35), 3 months postoperatively (65% vs 81%, p = 0.16), and at last follow-up (65% vs 76%, p = 0.34). A similar incidence of postoperative complications was observed in the 2 groups. CONCLUSIONS PBC is effective in the treatment of trigeminal neuralgia in patients with MS, but, compared with that in non-MS patients, symptom recurrence is higher and requires multiple procedures.

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

2011 ◽  
Vol 69 (2a) ◽  
pp. 221-226 ◽  
Author(s):  
Wuilker Knoner Campos ◽  
Marcelo N. Linhares
Keyword(s):  
Trigeminal Neuralgia ◽  
Female Gender ◽  
Safe Procedure ◽  
Approval Ratings ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Face ◽  
The Right ◽  
A Prospective Study

OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54%), the right side of the face (84%) and V2V3 roots of trigeminal nerve (33%). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80%) were pain-free after 50 months with a 90% satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

TM2-4 Long term outcome of percutaneous balloon compression for trigeminal neuralgia

2019 ◽  
Vol 90 (3) ◽  
pp. e13.3-e12 ◽  
Author(s):  
D Bhargava ◽  
P Cristaldi ◽  
P Franceschini ◽  
P Eldridge ◽  
J Osman-Farah
Keyword(s):  
Trigeminal Neuralgia ◽  
Symptom Relief ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Retrospective Audit ◽  
Percutaneous Balloon Compression ◽  
Anaesthesia Dolorosa

ObjectivesPercutaneous balloon compression (PBC) can be offered to medically refractory patients with trigeminal neuralgia who are unsuitable for microvascular decompression. Its associated with up to 4% risk of anaesthesia dolorosa which increases with duration and severity of compression and is more common with repeat procedures. We audited our outcomes for this procedure over last 7 years.DesignRetrospective audit of prospectively collected data.SubjectsAll patients undergoing PBC at our centre.MethodsTheatre and radiology records reviewed to identify patients. Case notes and radiology reviewed for history, diagnosis, details of procedure, immediate symptom relief, complications, further procedures and last follow up. Descriptive, comparative Kaplan Meir analysis undertaken.ResultsTotal 93 patients (4 b/l), 165 procedures. Average follow up 36 months. 24 patients had MS, 17 patients had atypical pain. All except 4 patients had good immediate pain relief. No patient developed anaesthesia dolorosa, 2 patients had transient diplopia, 1 maxillary hematoma and 1 infection. 56 experienced recurrence, 43 needed further surgical intervention. 25 PBC twice, 11 thrice, 4 four times and 1 five times. Average time to first recurrence=32 months. 85% pain free at 1 year and 70% at 2 years.ConclusionsPBC is an effective procedure. With conservative approach, this procedure can be safely repeated.

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