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

Objectives. To compare 3D-CT-guided and C-arm-guided percutaneous balloon compression (PBC) in terms of effectiveness and safety. Methods. The medical records and follow-up data of patients with idiopathic trigeminal neuralgia who underwent 3D-CT-guided or C-arm-guided PBCs in Beijing Tiantan Hospital and the Characteristic Medical Center of the Chinese People’s Armed Police Force between February 2018 and March 2020 were retrospectively reviewed and analysed. Results. A total of 291 patients were included. Among them, 212 patients underwent PBC treatment with 3D-CT and others with C-arm. One (0.5%) patient in 3D-CT group and 4 (5.1%) patients in C-arm group failed to receive PBC treatment because of failure of foramen ovale (FO) puncture ( P = 0.020 ). Among patients with successful attempts, 5 (2.4%) patients in the 3D-CT group and 11 (14.7%) patients in the C-arm group received more than one needle pass during the procedure ( P < 0.001 ). The 3D-CT group required less time than the C-arm group for puncture ( P < 0.001 ) and for the whole operation ( P < 0.001 ). The groups shared similar initial relief rates ( P = 0.749 ) and similar recurrence-free survival during follow-ups for a median of 22 months ( P = 0.839 ). No puncture-related complications occurred in either group and the two groups had similar incidences of compression-related complications. Conclusion. 3D-CT facilitated FO puncture and improved success rate of PBC. The overall time efficiency of PBC was also increased with 3D-CT. Thus, 3D-CT is a potentially useful image guidance technology for treating idiopathic trigeminal neuralgia by PBC.

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

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.

Prognostic Nomogram for Percutaneous Balloon Compression in the Treatment of Trigeminal Neuralgia

Because of its convenience and safety, percutaneous balloon compression (PBC) has become a more popular remedy for trigeminal neuralgia (TN) recently. The objective of this study was to establish a nomogram that can be used to preoperatively prognosticate the likelihood of pain-free based on preoperative disease characteristics. Clinical data were collected from those TN cases who had undergone PBC during the period of 2015 and 2020 in Qingdao municipal hospital. We excluded the cases caused by space-occupying lesion or had undergone MVD, Percutaneous glycerol rhizotomy (PGR) and glycerol rhizotomy (GR). A nomogram was established based on the results of multivariable logistic analysis. A receiver operating characteristic curve (ROC) analysis was applied to evaluate the reliability of models. The plotted decision curves were also used to assess the net benefit of nomogram-assisted decisions. Internal validation was performed using the ROC by bootstrap sampling. Finally, 16 cases and 69 cases were included into the ineffective and effective groups respectively. In the crude, adjust I and adjust II models, response to carbamazepine positively, the grade II or III compression severity score and classical TN type were all considered to be significant predictors of pain relief (BNI grades I-III) at 3 months follow-up. The AUC, accuracy, specificity, and sensitivity of the nomogram system was 0.83, 0.85, 0.75, 0.87 respectively for predicting patient outcomes. The decision curves showed good performance for the nomogram system in terms of clinical application. While, more research with validation in multiple, external independent patient populations is needed.

Clinical Effect of Partial Sensory Root Rhizotomy on Recurrence of Multiple Sclerosing Trigeminal Neuralgia After Percutaneous Balloon Compression

Objective To investigate the Clinical effect of partial sensory root rhizotomy(PSR) on recurrence of multiple sclerosing trigeminal neuralgia(TN-MS) after percutaneous balloon compression(PBC). Methods A retrospective analysis of the clinical data of 21 cases of recurrent multiple sclerosis trigeminal neuralgia after PBC who were treated with PSR in the Department of Neurosurgery of Xinxiang Central Hospital from January 2012 to July 2018; The diagnosis of MS was made by McDonald criteria, and using MRI to exclude REZ Regional blood vessels compress nerves; analysis of patients' preoperative and postoperative Visual Analogue Score (VAS), VAS 0-3 points means effective, 4 points and above means invalid or recurrence.Results Preoperative VAS: 8 -10 points in 21 cases, 1 day and 6 months after surgery VAS: 0-3 points in 21 cases, effective rate 100%; 12 months after surgery: 4 points in 2case, effective rate 95%, recurrence rate 5%; 18 months after surgery, 4 cases scored above 4, the effective rate was 81%, and the recurrence rate was 19%. The average point of VAS after PSR at 1 day, 6M, 12M, and 18M were lower than PBC, P<0.05, and the difference was statistically significant. The postoperative recurrence rate of PSR at 6M, 12M, and 18M is lower than that of PBC, P<0.05, and the difference is statistically significant. All 21 patients had facial sensation loss after surgery without major complications such as intracranial hemorrhage, facial palsy, and cerebrospinal fluid leakage. 1 case of intracranial infection. Conclusion PSR is effective in the treatment of TN-MS and can be used as a treatment for recurrence after PBC.

Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

ABSTRACT Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.