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

Machine learning to predict radiomics models of classical trigeminal neuralgia response to percutaneous balloon compression treatment

Background

Classic trigeminal neuralgia (CTN) seriously affects patients' quality of life. Percutaneous balloon compression (PBC) is a surgical program for treating trigeminal neuralgia. But some patients are ineffective or relapse after treatment. The aim is to use machine learning to construct clinical imaging models to predict relapse after treatment (PBC).

Methods

The clinical data and intraoperative balloon imaging data of CTN from January 2017 to August 2023 were retrospectively analyzed. The relationship between least absolute shrinkage and selection operator and random forest prediction of PBC postoperative recurrence, ROC curve and decision -decision curve analysis is used to evaluate the impact of imaging histology on TN recurrence.

Results

Imaging features, like original_shape_Maximum2D, DiameterRow, Original_Shape_Elongation, etc. predict the prognosis of TN on PBC. The areas under roc curve were 0.812 and 0.874, respectively. The area under the ROC curve of the final model is 0.872. DCA and calibration curves show that nomogram has a promising future in clinical application.

Conclusion

The combination of machine learning and clinical imaging and clinical information has the good potential of predicting PBC in CTN treatment. The efficacy of CTN is suitable for clinical applications of CTN patients after PBC.

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.

A combined radiomics and anatomical features model enhances MRI-based recognition of symptomatic nerves in primary trigeminal neuralgia

Background

The diagnosis of primary trigeminal neuralgia (PTN) in radiology lacks the gold standard and largely depends on the identification of neurovascular compression (NVC) using magnetic resonance imaging (MRI) water imaging sequences. However, relying on this imaging sign alone often fails to accurately distinguish the symptomatic side of the nerve from asymptomatic nerves, and may even lead to incorrect diagnoses. Therefore, it is essential to develop a more effective diagnostic tool to aid radiologists in the diagnosis of TN.

Purpose

This study aims to establish a radiomics-based machine learning model integrating multi-region of interest (multiple-ROI) MRI and anatomical data, to improve the accuracy in differentiating symptomatic from asymptomatic nerves in PTN.

Methods

A retrospective analysis of MRI data and clinical anatomical data was conducted on 140 patients with clinically confirmed PTN. Symptomatic nerves of TN patients were defined as the positive group, while asymptomatic nerves served as the negative group. The ipsilateral Meckel's cavity (MC) was included in both groups. Through dimensionality reduction analysis, four radiomics features were selected from the MC and 24 radiomics features were selected from the trigeminal cisternal segment. Thirteen anatomical features relevant to TN were identified from the literature, and analyzed using univariate logistic regression and multivariate logistic regression. Four features were confirmed as independent risk factors for TN. Logistic regression (LR) models were constructed for radiomics model and clinical anatomy, and a combined model was developed by integrating the radiomics score (Rad-Score) with the clinical anatomy model. The models' performance was evaluated using receiver operating characteristic curve (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results

The four independent clinical anatomical factors identified were: degree of neurovascular compression, site of neurovascular compression site, thickness of the trigeminal nerve root, and trigeminal pons angle (TPA). The final combined model, incorporating radiomics and clinical anatomy, achieved an area under the curve (AUC) of 0.91/0.90 (95% CI: 0.87-0.95/0.81-0.96) and an accuracy of approximately 82% in recognizing symptomatic and normal nerves.

Conclusion

The combined radiomics and anatomical model provides superior recognition efficiency for the symptomatic nerves in PTN, offering valuable support for radiologists in diagnosing TN.

Do bubbles matter amid PBC for trigeminal neuralgia?

BACKGROUND

As a simple and safe alternative intervention, percutaneous balloon compression (PBC) has been gradually adopted by a growing number of neurosurgeons to treat trigeminal neuralgia. A pear-shaped opacity observed fluoroscopically, which indicates full suffusion of Meckel's cave conducting sufficient pressure against Gasserian ganglion, is believed to be the key to its success. Sometimes, a bitten pear may appear due to bubbles in the balloon but is usually ignored.

OBJECTIVE

This study aims to investigate the effects of the bubbles on postoperative outcomes.

METHODS

Patient data were obtained from the consecutive cases undergoing PBCs in our department between 2019 and 2021. Among them, pain and numbness were used to assess the efficacy of PBC based on Barrow Neurology Institute (BNI) scoring system. It was defined as an effective outcome if the postoperative pain intensity grade was lower than II. And those with numbness grade > II were regarded as numb incidence.

RESULTS

We eventually recruited 59 cases, including 42 in full pear and 17 in bitten pear groups with follow-up time up to 44 months. The early effective rates were 95.2% and 82.4%, respectively (p > 0.05), which turned to 88.1% and 52.9% during the last follow-up period (p < 0.01). This result indicated that the bitten pear gave rise to a significantly higher recurrence. In terms of numbness, there was no significant difference.

CONCLUSION

Gas does not yield enough pressure as liquid, and cannot exert enough pressure to the semilunar ganglion. Therefore, air evacuation should not be ignored before injection.

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.

A prospective cohort study on perioperative percutaneous balloon compression for trigeminal neuralgia: safety and efficacy analysis

With the recent emergence of percutaneous balloon compression (PBC) as a promising treatment for trigeminal neuralgia (TN), there is a growing need for research on its safety and efficacy. This study was designed to evaluate the safety and efficacy of PBC in the treatment of TN patients during the perioperative period. This study involved a total of 400 TN patients who were selected and treated with PBC at our institution. The clinical data and short-term outcomes were analyzed based on sex, initial PBC treatment for TN, and subsequent PBC treatment for recurrent TN after previous PBC or microvascular decompression (MVD) or radiofrequency thermocoagulation (RFT). No statistically significant difference was found when comparing postoperative pain relief between male and female patients with TN. Nevertheless, female patients were found to be more vulnerable than male patients to abnormal facial sensations (P = 0.001), diplopia (P = 0.015), postoperative headache (P = 0.012), and hyposmia (P = 0.029). Additionally, it was observed that there was no substantial difference in the postoperative pain relief rate between the first-time PBC group and PBC for recurrent TN patients postoperatively following procedures such as PBC, MVD, and RFT. In conclusion, this study has shown that PBC treatment is effective in managing TN in both males and females, regardless of whether the treatment was administered as a primary intervention or following prior surgical procedures such as PBC, MVD, or RFT. Nonetheless, it is noted that the risk of postoperative complications appears to be higher in female patients compared to male patients.

Independent association of the Meckel's cave with trigeminal neuralgia and development of a screening tool

PURPOSE

To 1) investigate the association of the properties of the Meckel's cave (MC) with TN occurrence (i.e., affected vs. unaffected nerves) and whether such association was independent of neurovascular contact (NVC); and 2) develop an objective screening tool for TN.

MATERIALS AND METHODS

Two hundred and nineteen trigeminal nerves were included. (The severity of) NVC was identified for individual nerve, and a set of 107 radiomic features were extracted to characterize various properties of each MC. Both procedures were primarily based on magnetic resonance imaging sequences. A radiomic score (Rad-score) was constructed for each MC to integrate the features associated with TN occurrence. Independent t-test and logistic regression were conducted to assess the association and develop the screening tool mentioned above.

RESULTS

Twelve features were selected to build the Rad-score, with the Inverse Difference Moment Normalized (IDMN) having the greatest weight. The Rad-score was significantly (p ≤ 0.05) higher in the affected compared to the unaffected nerves, irrespective of NVC. The Rad-score and NVC were incorporated in the regression model/screening tool, which demonstrated an acceptable discriminating ability (C-statistic = 0.84).

CONCLUSION

This study has identified a potential association of the properties/features of the MC with TN occurrence, probably involving the demyelination and axonal injury of the trigeminal ganglion within the MC as suggested by the IDMN. Such association may be independent of NVC. This finding may provide new insight into the etiology and/or pathophysiology of TN. The screening tool, which demonstrated an acceptable discriminating ability, may contribute to an improvement in its diagnosis.

Gadolinium-based MR cisternography with prepontine cisternal routine for evaluating distribution pattern of intrathecal targeted drug delivery in pain management

Gadolinium-based MR cisternography has been mainly applied in clinical evaluation of cerebrospinal fluid leaking, that is conducted by intrathecal administration of contrast media. Recently, we have reported one novel technique of intrathecal targeted drug delivery with prepontine cisternal routine to treat orofacial cancer pain. The aim of this study was to examine the distribution pattern of this intrathecal drug delivery strategy. Here, we introduce one case who suffered severe orofacial pain caused by sublingual gland tumor, and successfully attenuated by prepontine cisternal administration of analgesic agents. To assess the distribution of intrathecal drugs, postoperative MR images of brain, cervical, thoracic, and lumbar segments in axial, coronal, and sagittal planes were obtained after application of gadolinium. The perfusion rate of contrast medium was set at 0.01 mmol per hour for 24 hours prior to MR scanning. In the T1-weighted images, we can identify contrast spread not only locating around the site of the intrathecal catheter tip, but also concentrated to the lateral sides. None obvious side effect was found after intrathecal injection of contrast media. Thus, our finding demonstrated the local distribution phenomenon of intrathecal drugs through prepontine cisternal access, and the bilateral perfusion pattern may provide insights underlying the analgesic mechanism of trigeminal pain provided by this novel intrathecal therapy. Gadolinium-based MR cisternography may serve as a potential tool to confirm the therapeutic effect of intrathecal targeted drug delivery via prepontine cisternal routine in orofacial pain management.

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.

Predictive value of foramen ovale size on pain recurrence after percutaneous balloon compression

OBJECTIVES

Primary trigeminal neuralgia (PTN) is a common cranial nerve disease in neurosurgery, which seriously endangers the physical and mental health of patients. Percutaneous balloon compression (PBC) has become an effective procedure for the treatment of PTN by blocking pain conduction through minimally invasive puncture. However, the recurrence of facial pain after PBC is still a major problem for PTN patients. Intraoperative balloon shape, pressure and compression time can affect the prognosis of patients with PBC after surgery. The foramen ovale size has an effect on the balloon pressure in Meckel's lumen. This study aims to analyse the predictive value of foramen ovale size for postoperative pain recurrence of PBC by exploring the relationship between foramen ovale size and postoperative pain recurrence of PBC.

METHODS

A retrospectively analysis was conducted on the clinical data of 60 patients with PTN who were treated with PBC in Department of Neurosurgery, Affiliated Hospital of Chengde Medical College from November 2018 to December 2021. We followed-up and recorded the Barrow Neurological Institute (BNI) pain score at 1, 3, 6 and 12 months after operation. According to the BNI pain score at 12 months after surgery, the patients were divided into a cure group (BNI pain score I to Ⅱ) and a recurrence group (BNI pain score Ⅲ to Ⅴ). The long diameter, transverse diameter and area of foramen ovale on the affected side and the healthy side of the 2 groups were measured. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used for analysis the relationship between the recurrence of pain and the long diameter, transverse diameter, area of foramen ovale on the affected side, and aspect ratio, transverse diameter ratio, area ratio of foramen ovale on the affected side to healthy side in the 2 groups.

RESULTS

At the end of 12 months of follow-up, 50 (83.3%) patients had pain relief (the cured group), 10 (16.7%) patients had different degrees of pain recurrence (the recurrence group), and the total effective rate was 83.3%. There were no significant differences in preoperative baseline data between the 2 groups (all P>0.05). The long diameter of foramen ovale on the affected side, the long diameter ratio and area ratio of foramen ovale on the affected/healthy side in the cured group were significantly higher than those in the recurrence group (all P<0.05), and there were no significant differences in the transverse diameter and area of foramen ovale on the affected side and the transverse diameter ratio of foramen ovale on the affected/healthy side between the 2 groups (all P>0.05). The ROC curve analysis showed that the AUC of the long diameter of foramen ovale on the affected side was 0.290 (95% CI 0.131 to 0.449, P=0.073), and the AUC of aspect ratio of foramen ovale on the affected side to healthy side was 0.792 (95% CI 0.628 to 0.956, P=0.004). The AUC of area ratio of foramen ovale on the affected side to healthy side was 0.766 (95% CI 0.591 to 0.941, P=0.008), indicating that aspect ratio and area ratio of foramen ovale on the affected side to healthy side had a good predictive effect on postoperative pain recurrence of PBC. When aspect ratio of foramen ovale on the affected side to healthy side was less than 0.886 3 or area ratio of foramen ovale on the affected side to healthy side was less than 0.869 4, postoperative pain recurrence was common.

CONCLUSIONS

Accurate evaluation of the foramen ovale size of skull base before operation is of great significance in predicting pain recurrence after PBC.

Efficacy and safety of computed tomography-guided percutaneous balloon compression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia

Percutaneous balloon compression (PBC) of Gasserian ganglion has been popularly used to treat trigeminal neuralgia (TN), one of the most painful syndromes in human experience. Vertebrobasilar dolichoectasia (VBD) is a rare cause of TN and remains challenging to treat. To our knowledge, no study has reported the therapeutic outcome of PBC for VBD-related TN (VBD-TN). In this retrospective study, we collected and analyzed the medical records of all patients undergoing PBC procedure for VBD-TN under the guidance of CT plus three-dimensional reconstruction at the Pain Management Center of Beijing Tiantan Hospital from January 2017 to December 2022. All 23 patients (15 men and 8 women) had a substantial pain relief as modified Barrow Neurological Institute (BNI) I-IIIb immediately after procedure. The follow-up duration ranged from 2 to 63 months, and at the last follow-up visit, only 3 patients (13%) relapsed (BNI IV-V). The cumulative recurrence-free survival was 95%, 87%, and 74% within 1, 3, and 5 years, respectively. Patients' reported satisfactory rate was 100% as Likert scale 4-5 throughout the whole follow-up period, with no severe complications occurring. Our data revealed promising efficacy and safety of PBC procedure for treatment of VBD-TN, thus suggesting a valuable option for pain control in these rare cases of TN. However, there has been no supporting evidence that PBC treatment is a preferred option to other treatments.

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.

Prepontine cisternal routine for intrathecal targeted drug delivery in craniofacial cancer pain treatment: technical note

Intrathecal targeted drug delivery provides effective relief for cancer-related pain. However, its validation in management of craniofacial pain remains much less widely practiced, mainly due to the localized diffusion of analgesic agent with current approach. Here, we report our experience of prepontine cisternal routine for placement and implantation of intrathecal targeted drug delivery in two cases of cancer-related craniofacial pain. Lumbar cannulation was applied and the intrathecal catheter tip was positioned at the prepontine cistern under fluoroscopic guidance during the surgical implantation. Postoperative imaging confirmed that the catheter tip was successfully placed in the prepontine cisternal space. Satisfactory control of pain was achieved after intrathecal therapy, with significant reduction of background and breakthrough cancer pain. None obvious complications were observed in this study. Thus, our novel intrathecal routine may provide an alternative option for craniofacial pain caused by tumor, who were insufficiently treated by oral analgesic agents.

Narrow ovale foramina may be involved in the development of primary trigeminal neuralgia

Background

The etiology of primary trigeminal neuralgia remains unclear and is worthy of further study; In this study, the morphometric characteristics of ovale foramina between various groups were compared and analyzed to explore the novel cause of primary trigeminal neuralgia.

Methods

High-resolution three-dimensional reconstruction images from head computed tomography of 109 patients with primary trigeminal neuralgia affecting the third branch of the trigeminal nerve and 46 healthy controls were retrospectively reviewed. Among the 109 primary trigeminal neuralgia patients, 79 patients with apparent neurovascular compression (not simply contact) demonstrated on MRI or during surgery were divided into the classical trigeminal neuralgia group and 30 patients with MRI showing no significant abnormalities were divided into idiopathic trigeminal neuralgia group. The morphometric parameters including the area, width and length of ovale foramina were examined through the use of radiologic methods.

Results

In this study, the average minimum area, width and length of 79 ovale foramina on the affected and unaffected sides in the classical trigeminal neuralgia group were 21.83 ± 8.45, 21.94 ± 7.93 mm², 2.32 ± 0.91, 2.58 ± 0.81, 5.32 ± 1.29, and 5.26 ± 1.21 mm, respectively. No significant difference in these parameters was observed (p > 0.05). However, in the idiopathic trigeminal neuralgia group, the average minimum area, width and length of 30 ovale foramina were 21.33 ± 8.21, 22.85 ± 8.36 mm², 2.25 ± 0.90, 2.79 ± 0.96, 5.20 ± 1.27, and 5.28 ± 1.19 mm, respectively. The width on the symptomatic side was significantly smaller (p = 0.03) than that on the asymptomatic side. No significant difference in area (p = 0.48) or length (p = 0.79) was observed. In addition, when compared with the healthy control group, the area and width of ovale foramina on the symptomatic side in both groups were significantly smaller. No significant difference in length was observed.

Conclusions

By comparing and analyzing the statistical data, it can be inferred that a narrow foramen ovale is associated with primary trigeminal neuralgia, as well as its recurrence after microvascular decompression.

Continuous Intra-Arterial Blood Pressure Monitoring Improves the Efficiency of Percutaneous Balloon Compression of the Trigeminal Ganglion for Trigeminal Neuralgia

Objective

The aim of the study is to explore the characteristics of systolic blood pressure (SBP) and heart rate (HR) changes in patients undergoing percutaneous balloon compression (PBC) for trigeminal neuralgia and analyze the factors that influence the formation of the symbolic pear shape of the balloon, which signifies successful compression.

Methods

We retrospectively analyzed the changes in systolic blood pressure (SBP) and heart rate (HR) in 103 consecutive patients with trigeminal neuralgia (TN). Fifty-five patients who underwent operations with intermittent inflating cuff blood pressure (IICBP) monitoring were classified into the IICBP group. The other 48 patients who underwent continuous intra-arterial blood pressure (CIABP) monitoring were classified into the CIABP group.

Results

Among all the patients, there were more women than men and the patients in both the groups more commonly had TN on the right side and involving branch III. First, the balloon appeared as “pear-shaped” when the compression was effective, and the SBP increased an average of 59.04% in the CIABP group. CIABP provided us the precise range of the increase. Older patients had higher SBPs, especially patients with hypertension. Second, SBP was more sensitive and lasted much longer than HR in the process of puncturing the foramen ovale and compressing the ganglion. SBP fluctuated much more in the CIABP group than in the IICBP group. Third, the median time taken in the CIABP group was less than the IICBP group, and the prognosis of the CIABP group was better than the IICBP group.

Conclusion

Effective ganglion compression significantly increased SBP. CIABP can monitor SBP in real time and can also safeguard the compression process. CIABP is a safe and effective method in the PBC process that is worthy of promotion and application.

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

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.

Factors that may affect recurrence of trigeminal neuralgia after percutaneous balloon compression

OBJECTIVE

To investigate the efficacy of percutaneous balloon compression of the Gasserian Ganglion (PCGG) in the treatment of trigeminal neuralgia(TN)and the influencing factors of recurrence after PCGG.

METHODS

The clinical data of 221 patients with TN treated by PCGG were retrospectively analyzed and followed-up to explore the postoperative efficacy.

RESULTS

There were 158 cases of immediate disappearance of pain and 59 cases of delayed pain disappearance in patients after one PCGG operation, for an overall efficacy rate of 98.2%. Forty-nine patients experienced recurrence of pain, for a recurrence rate of 22.6%, and average recurrence time of 18 months. The effective rate of medication in patients with recurrent trigeminal neuralgia is 85.7%.Univariate and multivariate logistic regression analyses showed that hypertension disease and delayed pain disappearance were independent factors for recurrence. The incidence of inhibitory reaction of the trigeminal nerve during the operation was 97.3%. The most common postoperative complications were facial numbness, masticatory-muscle weakness, tinnitus, diplopia and keratitis, which occurred at rates of 76.9%, 28.1%, 14.5%, 11.8% and 10.4%, respectively. All of the complications resolved within 3 years after PCGG.

CONCLUSIONS

PCGG is a safe and effective surgical method for the treatment of TN. The pain in most patients disappeared after surgery, leaving sequelae such as facial numbness, masticatory-muscle weakness and tinnitus. The mean time to recurrence of postoperative pain was 18 months, with hypertension disease and delayed pain disappearance as associated factors.

Clinical Analysis of the Treatment of Primary Trigeminal Neuralgia by Percutaneous Balloon Compression

Purpose

To summarize the technical points and clinical effects of percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia.

Methods

The clinical data of 13 patients with trigeminal neuralgia who received PBC from April 2020 to July 2021 were retrospectively analyzed. VAS, VRS-4 and PPI were used to evaluate the postoperative pain relief. Different postoperative complications were analyzed.

Results

All patients had a smooth operation, the inflation volume of the balloon was 0.7 ml, the average compression time was 120 s, and there was no balloon rupture during the operation. On the day after operation, 12 patients (92.3%) had complete pain relief, and 1 patient (7.7%) was not satisfied with pain relief, but the pain disappeared 2 weeks after the operation. After operation, there were 12 patients with facial numbness in the affected side (92.3%), 3 patients with masseter muscle weakness (23.0%), 1 patient with herpes around the mouth (7.6%), and 1 patient with diplopia (7.6%).

Conclusion

PBC is an effective minimally invasive surgical method for the treatment of primary trigeminal neuralgia. It is suitable for the elderly and infirm people, those who cannot tolerate general anesthesia or are afraid of surgery, and patients who had undergone surgery but relapsed after surgery. However, it is necessary to pay attention to the serious facial numbness and postoperative masticatory weakness. These discomforts are generally relieved after half a year.