Irish Journal of Medical Science (1971 -)

, Volume 184, Issue 4, pp 745–751 | Cite as

Percutaneous balloon compression (PBC) of trigeminal ganglion for recurrent trigeminal neuralgia after microvascular decompression (MVD)

Original Article

Abstract

Background

Although microvascular decompression (MVD) has become the best surgical treatment for trigeminal neuralgia, it does not achieve 100 % cure rate. Re-exploration of the posterior fossa may carry increased risk over first-time MVD and is not always successful, so other treatments are needed.

Aims

In this study, we evaluate the effectiveness of the patients with recurrent trigeminal neuralgia after MVD treated with percutaneous balloon compression (PBC).

Methods

The clinical data of 52 recurrent trigeminal neuralgia patients after MVD who underwent PBC between November 2007 and March 2012 were retrospectively reviewed and analyzed.

Results

After the PBC, 50 patients (96.2 %) experienced immediate pain relief; 1 patient had occasional pain, and did not require medication; and 1 patient had no pain relief. The total efficiency was 98.1 %. With a mean length of follow-up of 37.6 months, ranging from 12 to 64 months after surgery, 43 (82.7 %) patients remained pain-free, 4 patients (7.7 %) had mild recurrence, and 3 patients (5.8 %) had severe recurrence. The mean time to recurrence was 25.1 months (5–60 months). PBC was repeated a second time in three patients, a third time in one patient. Postoperative complications included facial numbness in 51 patients (98.1 %), masseter muscle weakness in 31 patients (59.6 %), paresthesia in 5 patients (9.6 %), and diplopia secondary to abducens nerve palsy in 1 patient (1.9 %). None of the patients had serious surgical morbidities.

Conclusions

PBC is a minimally invasive, safe and effective procedure which can be regarded as an optimized choice for recurrent trigeminal neuralgia after MVD.

Keywords

Recurrent Trigeminal neuralgia Microvascular decompression Percutaneous balloon compression 

Notes

Conflict of interest

None.

References

  1. 1.
    Jannetta PJ (1967) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26:159–162CrossRefPubMedGoogle Scholar
  2. 2.
    Sekula RF Jr, Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD (2011) Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis. J Neurosurg 114:172–179CrossRefPubMedGoogle Scholar
  3. 3.
    Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia:literature study of respective long-term outcomes. Aeta Neuraehir (Wien) 150:243–255CrossRefGoogle Scholar
  4. 4.
    Matsushima T, Yamaguchi T, Inoue TK, Matsukado K, Fukui M (2000) Recurrent trigeminal neuralgia after microvascular decompression using an interposing technique. Acta Neurochir (Wien) 142:557–561CrossRefGoogle Scholar
  5. 5.
    Tyler-Kabara EC, Kassam AB, Horowitz MH, Urqo L, Hadjipanayis C, Levy EI, Chang YF (2002) Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:527–531CrossRefPubMedGoogle Scholar
  6. 6.
    Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083CrossRefPubMedGoogle Scholar
  7. 7.
    Mullan S, Lichtor T (1983) Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia. J Neurosurg 59:1007–1012CrossRefPubMedGoogle Scholar
  8. 8.
    LichtorT Mullan JF (1990) A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion. J Neurosurg 72:49–54CrossRefGoogle Scholar
  9. 9.
    Skirving DJ, Dan NG (2001) A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 94:913–917CrossRefPubMedGoogle Scholar
  10. 10.
    Rath SA, Klein HJ, Richter H (1996) Findings and long-term results of subsequent operation after failed microdecompression for trigeminal neuralgia. Neurosurgery 39:933–940PubMedGoogle Scholar
  11. 11.
    Lee SH, Levy EI, Scarrow AM, Kassam A, Jannetta PJ (2000) Recurrent trigeminal neuralgia attributable to veins after microvascular decompression. Neurosurgery 46:356–361 (discussion 361-2)CrossRefPubMedGoogle Scholar
  12. 12.
    Amador N, Pollock BE (2008) Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia. J Neurosurg 108:916–920CrossRefPubMedGoogle Scholar
  13. 13.
    Kureshi SA, Wilkins RH (1998) Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: surgical findings and therapeutic implications. Neurosurgery 43:1111–1117CrossRefPubMedGoogle Scholar
  14. 14.
    Uqwuanyi UC, Kitchen ND (2010) The operative findings in re-do microvascular decompression for recurrent trigeminal neuralgia. Br J Neurosurg 24:26–30CrossRefGoogle Scholar
  15. 15.
    Cho DY, Chang CG, Wang YC, Wang FH, Shen CC, Yang DY (1994) Repeat operations in failed microvascular decompression for trigeminal neuralgia. Neurosurgery 35:665–669CrossRefPubMedGoogle Scholar
  16. 16.
    Park SS, Lee MK, Kim JW, Jung JY, Kim IS, Ghang GG (2008) Percutaneous balloon compression of trigeminal ganglion for the treatment of idiopathic trigeminal neuralgia: experience in 50 patients. J Korean Neurosurg Soc 43:186–189PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Omeis I, Smith D, Kim S, Murali R (2008) Percutaneous balloon compression for the treatment of recurrent trigeminal neuralgia: long-term outcome in 29 patients. Stereotact Funct Neurosurg 86:259–265CrossRefPubMedGoogle Scholar
  18. 18.
    Chen JF, Lee ST (2003) Comparison of percutaneous trigeminal ganglion compression and microvascular decompression for the management of trigeminal neuralgia. Clin Neurol Neurosurg 105:203–208CrossRefPubMedGoogle Scholar
  19. 19.
    Kouzounias K, Lind G, Schechtmann G, Winter J, Linderoth B (2010) Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia. J Neurosurg 113:486–492CrossRefPubMedGoogle Scholar
  20. 20.
    Frank F, Fabrizi AP (1989) Percutaneous surgical treatment of trigeminal neuralgia. Acta Neurochir (Wien) 97:128–130CrossRefGoogle Scholar
  21. 21.
    Brisman R (2007) Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings. Stereotact Funct Neurosurg 85:94–98CrossRefPubMedGoogle Scholar
  22. 22.
    Sindou M, Leston J, Howeidy T, Decullier E, Chapuis F (2006) Micro-vascular decompression for primary trigeminal neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien) 148:1235–1245CrossRefGoogle Scholar
  23. 23.
    Li ST, Wang X, Pan Q, Hai J, Liu N, Shen F, Liu Z, Guan Y (2005) Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. Clin J Pain 21:311–316CrossRefPubMedGoogle Scholar
  24. 24.
    Brown JA, Chittum CJ, Sabol D, Gouda JJ (1996) Percutaneous balloon compression of the trigeminal nerve for the treatment of trigeminal neuralgia. Neurosurg Focus 1:e4CrossRefPubMedGoogle Scholar
  25. 25.
    Stomal-Slowinska M, Slowinski J, Lee TK, Uitti RJ, Deen HG, Reimer R, Cheshire WP Jr, Herzog-Bryan G, Wharen RE Jr (2011) Correlation of clinical findings and results of percutaneous balloon compression for patients with trigeminal neuralgia. Clin Neurol Neurosurg 11:14–21CrossRefGoogle Scholar
  26. 26.
    Chen JF, Tu PH, Lee ST (2012) Repeated percutaneous balloon compression for recurrent trigeminal neuralgia: a long-term study. World Neurosurg 77:352–356CrossRefPubMedGoogle Scholar
  27. 27.
    Campos WK, Linhares MN (2011) A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression. Arq Neuropsiquiatr 69:221–226CrossRefPubMedGoogle Scholar
  28. 28.
    Correa CF, Teixeira MJ (1998) Balloon compression of the Gasserian ganglion for the treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 71:83–89CrossRefPubMedGoogle Scholar
  29. 29.
    Lobato RD, Rivas JJ, Sarabia R, Lamas E (1990) Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia. J Neurosurg 72:546–553CrossRefPubMedGoogle Scholar
  30. 30.
    Asplund P, Linderoth B, Bergenheim AT (2010) The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia. J Neurosurg 113:498–507CrossRefPubMedGoogle Scholar
  31. 31.
    Lee ST, Chen JF (2003) Percutaneous trigeminal ganglion balloon compression for treatment of trigeminal neuralgia, part II: results related to compression duration. Surg Neurol 60:149–153 (discussion 153-4)CrossRefPubMedGoogle Scholar
  32. 32.
    Brown JA, McDaniel MD, Weaver MT (1993) Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurg 32:570–573CrossRefGoogle Scholar
  33. 33.
    Urculo E, Alfaro R, Arrazola M, Astudilio E, Rejas G (2004) Trochlear nerve palsy after repeated percutaneous balloon compression for recurrent trigeminal neuralgia: case report and pathogenic considerations. Neurosurgery 54:505–508 (discussion 508–9)CrossRefPubMedGoogle Scholar
  34. 34.
    Broggi G, Franzini A, Lasio G, Giorqi C, Servello D (1990) Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 patients. Neurosurgery 26:783–787CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  • Y. Du
    • 1
  • D. Yang
    • 1
  • X. Dong
    • 1
  • Q. Du
    • 1
  • H. Wang
    • 1
  • W. Yu
    • 1
  1. 1.The Department of NeurosurgeryThe First People’s Hospital of Hangzhou, Nanjing Medical UniversityHangzhouChina

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