Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Percutaneous ballon compression, a better choice for primary trigeminal neuralgia compared to microvascular decompression?

Objective

Demonstrate the superiority of percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia (PTN) compared to trigeminal microvascular decompression (MVD).

Methods

Clinical data, including immediate, short-term, and long-term pain relief, complications, duration of the operation, and postoperative hospital stay, were retrospectively analyzed for 114 patients diagnosed with PTN who were treated with either PBC or MVD between January 2018 and December 2021.

Results

There were no statistically significant differences observed in the pain relief rates between the two surgical methods at 24 h postoperatively (MVD: 91.07%, PBC: 96.55%), at 6 months postoperatively (MVD: 87.5%, PBC: 94.8%), at 1 year postoperatively (MVD: 83.90%, PBC: 94.80%), and at 2 years postoperatively (MVD: 78.60%, PBC: 72.40%). However, the incidence of meningitis following MVD was significantly higher than that following PBC (P < 0.005). Additionally, both the duration of the operation and the length of the postoperative hospital stay in the MVD group were longer than those in the PBC group (P < 0.005).

Conclusion

PBC demonstrates efficacy comparable to MVD while offering a simpler procedure, improved safety, and a shorter postoperative hospital stay. Therefore, it may serve as a viable alternative to MVD and could become the preferred surgical approach for treating PTN in the future.

Perioperative Evaluation and Monitoring of Percutaneous Balloon Compression in Treatment of Trigeminal Neuralgia

BACKGROUND AND OBJECTIVES

Multiple factors may influence the clinical outcomes of percutaneous balloon compression (PBC), including intraluminal balloon pressure, volume, and Meckel's cave volume. In this article, we aimed to investigate the clinical value of the perioperative assessment and monitoring of balloon compression in the treatment of trigeminal neuralgia (TN).

METHODS

Thirty-seven patients who underwent PBC were prospectively enrolled. The patient underwent preoperative high-resolution 3.0-T MRI for the 3-dimensional reconstruction of Meckel's cave, while intraoperative recordings of intraluminal pressure and balloon volume were conducted simultaneously. Primary outcomes included postoperative numbness and pain recurrence up to 24 months after discharge.

RESULTS

Sensory deficiency was primarily reported within the first month, and approximately 38% of the patients presented with symptomatic numbness in the facial region. Subgroup analysis indicated no statistically significant difference in intraluminal balloon pressure between patients with facial numbness and asymptomatic individuals. This impairment in trigeminal sensation eventually recovered at the 24-month follow-up. By contrast, the long-term recurrence rate of TN was approximately 25% (5/20 patients) 2 years postoperatively. Furthermore, we found that the intraluminal balloon pressure was significantly lower among patients with recurrent pain (102.8 ± 11.0 vs 135.7 ± 5.1 kPa, P < .05). Although no significant differences in balloon or Meckel's cave volume were observed between subgroups, we found a positive and significant correlation between the volume of Meckel's cave and balloon.

CONCLUSION

Facial numbness remains a common but short-term symptom of PBC for TN. This study indicates that a higher intraluminal balloon pressure may be associated with a lower risk of recurrent trigeminal pain. Preoperative reconstruction of Meckel cave may help to predict the volume of intraoperative balloon compression. We consider it feasible and necessary to conduct a perioperative assessment of balloon compression in the treatment of TN.

Percutaneous Balloon Compression Guided by a Compression-Time Effect in Trigeminal Nerve Branches

BACKGROUND

Percutaneous balloon compression (PBC) is an important treatment for trigeminal neuralgia (TN). Establishing the duration of balloon compression involves a tradeoff between outcome and postoperative complications. We aimed to explore the effect of the duration of balloon compression on the numbness response in areas innervated by the branches of the trigeminal nerve.

METHODS

Thirty-three patients with TN were included as an exploratory cohort, and the response area and compression time to the onset of facial numbness were recorded intraoperatively. Seventy-six patients with TN were then randomly divided into experimental (EG) and control groups (CG) for validation. The EG was treated with balloon compression times adjusted to reflect the compression-time effect observed in the initial investigation, whereas the CG was treated with a standardized compression time of 180 s. Patients were followed up postoperatively for pain relief and facials to verify the reliability of the effect.

RESULTS

We found that the mean compression time to numbness in the region innervated by the ophthalmic meridian (V1) was 89.09 ± 8.99 s; by V1 and the maxillary nerve (V2), 123.52 ± 7.97 s; and by V1, V2, and the mandibular nerve (V3), 181.33 ± 10.29 s. All 76 patients used to verify the effect had complete relief of pain, and the EG had significantly less numbness than the CG.

CONCLUSION

In PBC, with the extension of balloon compression time, the numbness response of each branch of the trigeminal nerve appears in a certain order. This effect can guide PBC in mitigating complications while ensuring efficacy.

A nomogram based on radiomics and clinical information to predict prognosis in percutaneous balloon compression for the treatment of trigeminal neuralgia

OBJECTIVE

To develop a clinical-radiomics nomogram based on clinical information and radiomics features to predict the prognosis of percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia (TN).

METHODS

The retrospective study involved clinical data from 149 TN patients undergoing PBC at Zhongnan Hospital, Wuhan University from January 2018 to January 2022. The free open-source software 3D Slicer was used to extract all radiomic features from the intraoperative X-ray balloon region. The relationship between clinical information and TN prognosis was analyzed by univariate logistic analysis and multivariate logistic analysis. Using R software, the optimal radiomics features were selected using the least absolute shrinkage and selection operator (Lasso) algorithm. A prediction model was constructed based on the clinical information and radiomic features, and a nomogram was visualized. The performance of the clinical radiomics nomogram in predicting the prognosis of PBC in TN treatment was evaluated using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).

RESULTS

A total of 149 patients were eventually included. The clinical factors influencing the prognosis of TN in univariate analysis were compression severity score and TN type. The lasso algorithm Max-Relevance and Min-Redundancy(mRMR) was used to select two predictors from 13 morphology-related radiomics features, including elongation and surface-volume ratio. A total of 4 predictors were used to construct a prediction model and nomogram. The AUC was 0.886(95% confidence interval (CI), 0.75 to 0.96), indicating that the model's good predictive ability. DCA demonstrated the nomogram's high clinical applicability.

CONCLUSION

Clinical-radiomics nomogram constructed by combining clinical information and morphology-related radiomics features have good potential in predicting the prognosis of TN for PBC treatment. However, this needs to be further studied and validated in several independent external patient populations.

Proximal trigeminal nerve atrophy is associated with favourable outcomes and persistent facial numbness following percutaneous balloon compression for primary trigeminal neuralgia

OBJECTIVE

Whether nerve atrophy can affect the prognosis of primary trigeminal neuralgia (PTN) patients undergoing percutaneous balloon compression (PBC) remains unclear. This study aimed to determine the association between nerve characteristics observed on preoperative magnetic resonance imaging (MRI) and PBC outcomes.

METHODS

Between January 2019 and December 2022, a cohort of 58 patients with unilateral PTN treated with PBC were analysed retrospectively and included in this study. The relationship between MRI findings, including the proximal and distal nerve cross-sectional areas (CSAs), and favourable pain outcomes (BNI Grades I-III) was analysed through Kaplan‒Meier analysis.

RESULTS

After a mean follow-up period of 23.8 ± 13.0 months (range, 6-50 months), 48 (82.8%) patients with PTN were pain free with or without medication. A smaller proximal CSA ratio (proximal CSA of the affected nerve/proximal CSA of the unaffected nerve) was significantly associated with favourable outcomes. The Kaplan-Meier survival analysis showed that patients with proximal nerve atrophy (proximal CSA ratio ≤ 87% after receiver operating characteristic curve analysis) had a higher estimated 4-year probability of maintaining a favourable outcome than those without nerve atrophy (94.4% vs. 30.8%, p = 0.005). In addition, patients with proximal nerve atrophy were more likely to suffer from postoperative persistent facial numbness.

CONCLUSIONS

Proximal nerve atrophy is correlated with both favourable outcomes and persistent facial numbness following PBC. Prospective studies are required to determine the optimal duration and pressure of balloon compression in relation to the proximal CSA ratio to achieve better pain outcomes and less facial numbness.

A retrospective study to examine the association of different pear-shaped balloons with efficacy and postoperative complications in percutaneous balloon compression for trigeminal neuralgia

Percutaneous balloon compression is a safe and effective therapeutic modality for trigeminal neuralgia. It is widely recognized that the pear-shaped balloon is the key to the success of the procedure. This study aimed to analyze the effect of different pear-shaped balloons on the duration of the treatment outcome. In addition, the relationship between individual variables and the duration and severity of complications was analyzed. The clinical data and intraoperative radiographs of 132 patients with trigeminal neuralgia were reviewed. We classify pear-shaped balloons into type A, type B, and type C balloons depending on the size of their heads. The collected variables were correlated with prognosis by univariate and multivariate analyses. The efficiency of the procedure was 96.9%. There was no significant difference in pain relief rates between the different pear-shaped balloons. Median pain-free survival time was longer for type B and C balloons, which were significantly different from type A balloons. In addition, pain duration also was a risk factor for recurrence. There was no significant difference in the duration of numbness between the different types of pear-shaped balloons, but type C balloons resulted in longer-lasting masticatory muscle weakness. Duration of compression and balloon shape can also significantly influence the severity of complications. Different pear-shaped balloons have been shown to have a significant effect on the efficacy and complications of the PBC procedure, with type B balloons (head ratio: 10-20%) appearing to be the ideal pear shape. However, its clinical application remains to be validated.

Predictors of response for percutaneous balloon compression for the treatment of recurrent trigeminal neuralgia following surgical procedures: a retrospective study

Recurrent trigeminal neuralgia (TN) after surgical procedures can be rather difficult to treat, and standardized treatment measures are not available yet. It is unclear whether percutaneous balloon compression (PBC) can be used as the preferred surgical treatment for postoperative recurrent TN. To determine the efficacy of PBC and identify the predictors of response of PBC for the treatment of recurrent TN following TN-related surgeries, we retrospectively collected and analyzed the data of patients with recurrent TN following surgical treatments who underwent PBC under three-dimensional computed tomography (3D-CT) guidance at the Department of Pain Management of Beijing Tiantan Hospital, Capital Medical University from January 2018 to January 2022. We found, within 1 month after PBC, that the total efficacy of PBC on recurrent TN following TN-related surgeries was 86.7%. Based on the effectiveness of PBC 1 month postoperatively, patients were divided into the effective group (130, 86.7%) and the ineffective group (20, 13.3%). Fourteen (10.8%) patients in the effective group had undergone RFT before, which was significantly lower than that in the ineffective group (6, 30%, p = 0.02). Multivariate logistic regression analysis showed that previous RFT alone (OR = 0.20, 95%CI 0.06-0.66, P = 0.01) was an independent predictor of the negative response of PBC. Thus, PBC was found to be a moderately effective and safe treatment for recurrent TN after TN-related surgery. However, previous RFT procedures may predict a slightly worse outcome after PBC.

A Prospective Study to Examine the Association of the Foramen Ovale Size with Intraluminal Pressure of Pear-Shaped Balloon in Percutaneous Balloon Compression for Trigeminal Neuralgia

INTRODUCTION

Percutaneous balloon compression (PBC) is an effective and safe option for patients with trigeminal neuralgia. A pear-shaped balloon can be used to identify the proper compression of the Gasserian ganglion during the PBC procedure. The aim of this study was to evaluate the relationship between the foramen ovale (FO) size and intraluminal pressure of the pear-shaped balloon.

METHODS

Thirteen patients that presented with classical trigeminal neuralgia were scheduled to undertake PBC surgery at the Pain Department of the Third Xiangya Hospital, Central South University, from November 2020 to April 2021. Three-dimensional computed tomography reconstruction of the skull base was performed to capture the feature of FO preoperatively. The intraluminal pressure was continuously recorded when a pear-shaped balloon was obtained during the procedure. Correlation analysis was calculated to determine the association of the intraluminal balloon pressure with FO parameter.

RESULTS

All participants reported complete relief of pain at discharge. The enduring analgesic effect of PBC was maintained in all patients with a median follow-up up to 5.5 months (range, 3-8 months). The average intraluminal balloon pressure was 161.5 ± 29.4 kPa at the initial compression (P1), and 134.8 ± 21.5 kPa at the ending of compression (P2), respectively. P1 was significantly correlated with the length (r = 0.61, P = 0.024) of FO. Similarly, a significant and positive correlation was observed between P2 and the length (r = 0.63, P = 0.022) of FO.

CONCLUSIONS

Preoperative assessment of FO may be a potential predictor of intraluminal pressure to reach a pear-shaped balloon during PBC treatment. Narrow FO is associated lower intraluminal balloon pressure.