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

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Abstract

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.

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Data availability

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Ninth People’s Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China

    Shuo Li, Chenlong Liao, Guo Cheng, Yiwei Wu & Wenchuan Zhang

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Contributions

SL: conceptualisation, investigation data curation, and writing—original draft preparation; CL: writing—reviewing and editing; GC: software, validation, and methodology; YW: software, validation, and methodology; and WZ: supervision.

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Correspondence to Wenchuan Zhang.

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Comments

The authors of this article analyzed the size of the trigeminal nerve root in a series of patients with trigeminal neuralgia (TN) and discovered a higher likelihood of successful pain relief with percutaneous balloon compression in those who exhibited asymmetry between the affected and unaffected sides.

It remains unclear if the observed correlation has anything to do with the underlying mechanism of pain or the specific way the balloon compression produces long-lasting pain relief in TN patients. It is conceivable that nerve asymmetry is the reason TN patients develop pain in the first place, but the asymmetry may also be a result of prolonged nerve malfunction in TN patients when the nerve atrophies due to vascular compression or subsequent focal demyelination.

I applaud the authors for their thorough analysis of their clinical series but feel that it would be too early to make any recommendations in terms of choice of treatment approach or its technical details based on preoperative nerve morphometry.

Konstantin Slavin

Chicago, USA

Shuo Li and Chenlong Liao share the first authorship.

Yiwei Wu and Wenchuan Zhang share the last authorship.

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Li, S., Liao, C., Cheng, G. et al. Proximal trigeminal nerve atrophy is associated with favourable outcomes and persistent facial numbness following percutaneous balloon compression for primary trigeminal neuralgia. Acta Neurochir 165, 3867–3876 (2023). https://doi.org/10.1007/s00701-023-05849-3

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