One Hundred Eleven Percutaneous Balloon Compressions for Trigeminal Neuralgia in a Cohort of 66 Patients with Multiple Sclerosis

2019 ◽  
Vol 17 (5) ◽  
pp. 452-459 ◽  
Author(s):  
Pär Asplund ◽  
Bengt Linderoth ◽  
Göran Lind ◽  
Jaleh Winter ◽  
A Tommy Bergenheim
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Therapeutic Effect ◽  
Sensory Function ◽  
Resistant Disease ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Number Of Patients ◽  
Postoperative Time

Abstract BACKGROUND Trigeminal neuralgia associated with multiple sclerosis (MS–TN) is comparatively rare and larger series of percutaneous balloon compression (PBC) in such cases are few in the literature. OBJECTIVE To evaluate the results after PBC for MS–TN with regards to therapeutic effect, side effects, and complications. METHODS One hundred eleven procedures with PBC performed in 66 cases of MS–TN were analyzed. Therapeutic effect was measured as postoperative time to pain recurrence without medication. All complications were compiled and the sensory function was evaluated in a subgroup of cases. RESULTS The initial pain free rate was 67% and the median time to pain recurrence was 8 mo. Thirty-six patients were treated with PBC only, and among them, the results were worse if treated 3 to 4 times before, compared to first treatment (P = .009-.034). Patients who had several PBCs had worse results already after the first surgery (P < .001). A significant number of patients had impaired sensation to light touch directly after surgery, which was normalized at the late follow-up. Sensimetric testing showed raised thresholds for perception and pain directly after surgery (P = .004-.03), but these were also normalized at the late follow-up. CONCLUSION PBC is a treatment that can be effective for many patients with MS–TN. Repeated previous surgeries is a risk factor for an unsatisfactory outcome. However, the patients with multiple surgeries had less satisfactory results already at the first procedure, indicating that a therapy resistant disease can be predicted after the first two PBCs. Postoperative sensory deficits were common but not lasting.

The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia

2010 ◽  
Vol 113 (3) ◽  
pp. 498-507 ◽  
Author(s):  
Pär Asplund ◽  
Bengt Linderoth ◽  
A. Tommy Bergenheim
Keyword(s):  
Electrical Stimulation ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Therapeutic Effect ◽  
Sensory Function ◽  
Careful Study ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
The Impact

Object Percutaneous balloon compression is a simple and effective treatment of trigeminal neuralgia. However, results between and within different series are varying. To further improve the results in terms of pain relief, the authors believe that a careful study of the surgical procedure is important. The object of this study was to analyze the impact of balloon shape, balloon position, balloon volume, and compression time on duration of the therapeutic effect following percutaneous balloon compression. Furthermore, they analyzed the sensory side effects associated with this treatment, and how these relate to surgical parameters. Methods Medical records and intraoperative radiographs from 87 balloon compressions were reviewed, and different surgical parameters were categorized. Univariate and multivariate analyses were performed to correlate surgical parameters to pain relief. Sensory testing with a transcutaneous electrical stimulation technique and clinical examination data were reviewed to analyze changes in sensory function. Results The balloon shape had a significant impact on time to recurrence of pain. A pear-shaped balloon resulted in a far better surgical result than a non–pear-shaped balloon (p < 0.001). The difference between a distinct and a less distinct pear shape was not significant (p = 0.14). Statistical significance was not reached for any of the other parameters in relation to duration of therapeutic effect. A pear-shaped balloon was also significantly associated with increased thresholds for percutaneous electrical stimulation in the immediate postoperative period, but the perception thresholds were normalized at the late follow-up at 3–9 months. A similar outcome was found for clinical testing with light touch and pinprick. Conclusions The authors have demonstrated that using a pear-shaped balloon when performing percutaneous balloon compression for trigeminal neuralgia results in longer pain relief than non–pear-shaped balloons. Other surgical parameters seemed less important with respect to pain relief. Balloon compression also, in many cases, results in hypesthesia.

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.

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.

scholarly journals The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia

2021 ◽  
Author(s):  
Chenglong Sun ◽  
Wenhua Yu ◽  
Qiang Zhu ◽  
Quan Du
Keyword(s):  
Trigeminal Neuralgia ◽  
Therapeutic Effect ◽  
Gold Standard ◽  
Inflated Balloon ◽  
Surgical Result ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Anatomic Basis ◽  
Shape Changes

Abstract Background: The pear shape of an inflated balloon is thought to be a gold standard of a successful percutaneous balloon compression (PBC). However, neither how the balloon shape changes nor why it changes in that way (the anatomic basis) has not yet been fully described. Methods: Radiographs from over 150 percutaneous balloon compression (PBC) cases were thoroughly evaluated. We proposed a model of changing balloon shape in Meckel's cave (MC) and 70 cases were followed up over 2 years, in which therapeutic effect was measured.Results: We found that the balloon changed stereotypically in MC. The model that we proposed is consistent with the description of the structures of MC and its surroundings in the literature. The distinct pear (pear in MC) brought about a far better surgical result than other shapes (p < 0.01).Conclusion: Our study showed how and why the balloon shape changed during PBC surgery. The model provides favorable guidance for PBC surgery.

Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia

2010 ◽  
Vol 113 (3) ◽  
pp. 486-492 ◽  
Author(s):  
Konstantinos Kouzounias ◽  
Göran Lind ◽  
Gastón Schechtmann ◽  
Jaleh Winter ◽  
Bengt Linderoth
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Modalities ◽  
Recurrence Time ◽  
Chi Square ◽  
Balloon Compression ◽  
Duration Of Effect ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Chi Square Test

Object The aim of this study was to compare percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) in terms of effectiveness, complications, and technical aspects. Methods Sixty-six consecutive PBC procedures were performed in 45 patients between January 2004 and December 2008, and 120 PRGR attempts were performed in 101 patients between January 2006 and December 2008. The PRGR procedures were not completed due to technical reasons in 19 cases. Five patients in the Balloon Compression Group and 9 patients in the Glycerol Group were lost to follow-up and were excluded from the study. The medical records and the intraoperative fluoroscopic images from the remaining cases were retrospectively examined, and the follow-up was completed with telephone contact, when necessary. The 2 groups were compared in terms of initial effect, duration of effect, and rates of complications as well as severity and type of complications. Results The rates for immediate pain relief were 87% for patients treated with glycerol injection and 85% for patients treated with balloon compression. The Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence time was 21 months for the balloon procedure and 16 months for the glycerol procedure. When the groups were broken down by the “previous operations” criterion, the 50% recurrence time was 24 months for the Glycerol First Procedure Group, 6 months for the Balloon First Procedure Group, 8 months for the Glycerol Previous Procedures Group, and 21 months for the Balloon Previous Procedures Group. The rates of complications (excluding numbness) were 11% for PRGR and 23% for PBC, and this difference was statistically significant (chi-square test, p = 0.04). Conclusions Both PRGR and PBC are effective techniques for the treatment of trigeminal neuralgia, with PRGR presenting some advantages in terms of milder and fewer complications and allowing lighter anesthesia without compromise of analgesia. For these reasons the authors consider PRGR as the first option for the treatment of trigeminal neuralgia in patients who are not suitable candidates or are not willing to undergo microvascular decompression, while PBC is reserved for patients in whom the effect of PRGR has proven to be short or difficult to repeat due to cisternal fibrosis.

A 20-year review of percutaneous balloon compression of the trigeminal ganglion

2001 ◽  
Vol 94 (6) ◽  
pp. 913-917 ◽  
Author(s):  
David J. Skirving ◽  
Noel G. Dan
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Ganglion ◽  
Complication Rates ◽  
Entire Study ◽  
Content Type ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Fine Print

Object. The aim of this study was to investigate outcomes and complication rates associated with percutaneous balloon compression (PBC) of the trigeminal ganglion over a long follow-up period. Methods. This retrospective review was conducted in 496 patients with typical symptoms of unilateral trigeminal neuralgia who underwent 531 PBCs of the trigeminal ganglion between 1980 and 1999. The mean length of follow up was 10.7 years. The treatment used was a modification of that first described by Mullan and Lichtor in 1983. There were nine technical failures. Of the 522 successful procedures, prompt pain relief ensued in all patients except one. Recurrence of pain was found in 95 patients (19.2%) within 5 years and in 158 patients (31.9%) over the entire study period. Symptomatic dysesthesias occurred in 19 patients (3.8%), but corneal anesthesia and anesthesia dolorosa did not. Conclusions. In this review the authors present data on the largest cohort of patients with the longest follow up for this procedure in the current literature. The balance between the recurrence rate and troublesome sensory complications achieved in this series is favorable when compared with previously published studies on outcomes of PBC and the two alternative percutaneous methods, radiofrequency thermocoagulation and glycerol rhizolysis. The PBC procedure has additional advantages in that it is relatively straightforward and quick, and can be performed during a brief period of general anesthesia with no discomfort to the patient. This makes it an attractive first choice in the treatment of trigeminal neuralgia.

scholarly journals Long-term Follow-up of Trigeminal Neuralgia Patients treated with Percutaneous Balloon Compression Technique: A Retrospective Analysis

2016 ◽  
Vol 17 (3) ◽  
pp. 263-266 ◽  
Author(s):  
Suman Yadav ◽  
Rajratna M Sonone ◽  
Chandresh Jaiswara ◽  
Shipra Bansal ◽  
Deepak Singh ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Retrospective Analysis ◽  
Treatment Options ◽  
Compression Technique ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Long Term Follow Up

ABSTRACT Background Trigeminal neuralgia (TN) refers to sharp, lancinating pain in the areas supplied by trigeminal nerve. Both pharmacological and surgical lines of treatments are available for the treatment of TN. Percutaneous balloon compression (PBC) is one such surgical technique that is usually advocated for the treatment of TN occurring in elderly patients. Hence, we aim to evaluate the follow-up results of the TN patients treated by the PBC technique. Materials and methods A total of 400 patients were selected for the study who had undergone surgical treatment of TN by percutaneous balloon decompression technique. All the postoperative follow-up records of the patients, clinical history, and complication records of the patients were studied and evaluated. Results Of all the patients included in the study, 353 patients showed improvement clinically after PBC therapy. Out 400, 180 were males and 220 were females. Postoperative complications of the patients during their follow-up were also recorded and it was observed that the most common complication arising after treatment with this technique included facial numbness, masseter muscle weakness, paresthesia, diplopia, and corneal anesthesia. Conclusion One of the most common neuralgic pains affecting the face is the pain of TN. Although numerous lines of treatment options are available for its treatment, all these have one or the other drawbacks. From our results, we can conclude that PBC technique offers more advantages than other surgical modalities and, therefore, should be preferred over other techniques of treatment. How to cite this article Yadav S, Sonone RM, Jaiswara C, Bansal S, Singh D, Rathi VC. Long-term Follow-up of Trigeminal Neuralgia Patients treated with Percutaneous Balloon Compression Technique: A Retrospective Analysis. J Contemp Dent Pract 2016;17(3):263-266.

206 Percutaneous Balloon Compression as Treatment to Trigeminal Neuralgia: 14 Years of Experience in a Single Center

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 256-256
Author(s):  
Nilson Nogueira Mendes Neto ◽  
Jessika Thais da Silva Maia ◽  
Daniel Duarte Rolim ◽  
Marcelo Rodrigues Zacarkim ◽  
Juliano Jose da Silva ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Positive Influence ◽  
Functional Neurosurgery ◽  
Balloon Compression ◽  
Percutaneous Balloon ◽  
Percutaneous Balloon Compression ◽  
Safe Technique ◽  
Relief Rate

Abstract INTRODUCTION Percutaneous balloon compression of the Gasserian ganglionic has been used to treat Trigeminal Neuralgia (TN) since 1983. METHODS We performed a retrospective study on 222 patient's records which have received 242 procedures of Percutaneous Balloon Compression (PBC) as treatment for TN. A 6 months follow-up period after surgery was needed to be included in the study. They were operated at Functional Neurosurgery Unit in Brazil from February 2002 to July 2016. RESULTS >The patient's age ranged from 29 to 91 years (mean, 62, 2 years), 43% were males and 57% were females. Rare cases of bilateral trigeminal neuralgia were seen in 5 patients. Immediately after surgery, 193 (79,7%) patients became pain-free and 34 (14%) patients became pain free during the following 4 days. Carbamazepine was suspended in 93.7% of cases. Out of the total, only 13 (5,37%) patients related residual pain on follow-up. Hypoesthesia was reported after 83,8% of procedures. In addition, bradycardia was seen in 58,1% of cases during foramen ovale puncture. Transitory complications such as diplopia (2,47%), otalgia (1,23%) and tinnitus (1,23%) were reported. Regarding to balloon appearance, pear and dumb-bell shapes were detected in 74,8% and 7,4% of procedures, respectively. Only 15 (6,19%) patients needed a reoperation due to pain persistence. CONCLUSION PBC showed to be an effective and safe technique which provides high rates of pain relief (93,7%) in the following 6 months after surgery. The Carbamazepine's use was markedly reduced (93,7%). In addition, relapse of pain occurred in few cases (5,37%). Complications were minor and transitory. Comparing statistically, we can stat that the balloon shapes (82,2%) and hypoesthesia (83,8%) findings had a positive influence on pain relief rate (93,7%). Our findings support that PBC should be considered as primary surgical treatment of trigeminal neuralgia.

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