Abstract
As a minimally invasive treatment of trigeminal neuralgia, percutaneous balloon compression (PBC) has become increasingly popular worldwide. Because it is simple and straightforward, it does not need a complicated apparatus only a fluoroscope plus an operator’s experience. Therefore, the surgical technique seems to be essential and worth further addressing. The paper stresses that the target of PBC should be the semilunar ganglion (the soma of neurons) rather than the rootlets (axons) because the latter is renewable. To obtain a sufficient pressure against the ganglion, Meckel’s cave should be covered utterly by an inflating balloon, which fluoroscopically appears in a pear shape. To attain a proper balloon position, it is suggested to make a tunnel with a blunt stylet in a proper penetrative angle before inserting a soft catheter. Too large a pear is unnecessary, hence injecting should be stopped when growth becomes apparently slow. To avoid an unacceptable postoperative paresthesia, a prolonged compression is not encouraged.
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References
Cheng JS, Lim DA, Chang EF, Barbaro NM. A review of percutaneous treatments for trigeminal neuralgia. Neurosurgery. 2014;10:25–33. https://doi.org/10.1227/NEU.00000000000001687; discussion 33.
Cheng J, Lei D, Zhang H, Mao K. Trigeminal root compression for trigeminal neuralgia in patients with no vascular compression. Acta Neurochir. 2015;157:323–7. https://doi.org/10.1007/s00701-00014-02300-00709. Epub 2015 Jan 9.
Ishikawa M, Nishi S, Aoki T, Takase T, Wada E, Ohwaki H, Katsuki T, Fukuda H. Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism. J Clin Neurosci. 2002;9:200–4. https://doi.org/10.1054/jocn.2001.0922.
Revuelta-Gutierrez R, Lopez-Gonzalez MA, Soto-Hernandez JL. Surgical treatment of trigeminal neuralgia without vascular compression: 20 years of experience. Surg Neurol. 2006;66:32–6. https://doi.org/10.1016/j.surneu.2005.1010.1018; discussion 36.
Gubian A, Rosahl SK. Meta-analysis on safety and efficacy of microsurgical and radiosurgical treatment of trigeminal neuralgia. World Neurosurg. 2017;103:757–67. https://doi.org/10.1016/jwneu201710041085. Epub 2017 Apr 20.
Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, Ying TT, Yang XS, Zhan WC, Hua XM. A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg. 2012;114:846–51. https://doi.org/10.1016/j.clineuro.2012.1001.1021. Epub 2012 Feb 5.
Zhong J, Zhu J, Sun H, Dou NN, Wang YN, Ying TT, Xia L, Liu MX, Tao BB, Li ST. Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases. Neurol Res. 2014;36:882–93. https://doi.org/10.1179/1743132814Y.0000000344. Epub 2014 Mar 5.
Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–83. https://doi.org/10.1056/NEJM199604253341701.
Li MW, Jiang XF, Niu CS. Efficacy of and risk factors for percutaneous balloon compression for trigeminal neuralgia in elderly patients. Br J Neurosurg. 2020;3:1–5.
Ni H, Wang Y, Chen X, Gu W. Outcomes of treatment for elderly patients with trigeminal neuralgia: percutaneous balloon compression versus microvascular decompression. J Craniofac Surg. 2020;31(7):e685–8.
Skirving DJ, Dan NG. A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg. 2001;94:913–7. https://doi.org/10.3171/jns.2001.3194.3176.0913.
Ying X, Wang H, Deng S, Chen Y, Zhang J, Yu W. Long-term outcome of percutaneous balloon compression for trigeminal neuralgia patients elder than 80 years: a STROBE-compliant article. Medicine (Baltimore). 2017;96:e8199. https://doi.org/10.1097/MD.0000000000008199.
Belber CJ, Rak RA. Balloon compression rhizolysis in the surgical management of trigeminal neuralgia. Neurosurgery. 1987;20:908–13. https://doi.org/10.1227/00006123-198706000-198700015.
Brown JA, Chittum CJ, Sabol D, Gouda JJ. Percutaneous balloon compression of the trigeminal nerve for treatment of trigeminal neuralgia. Neurosurg Focus. 1996;1:e4. https://doi.org/10.3171/foc.1996.3171.3172.3111; discussion 1 p following e4.
Fraioli B, Esposito V, Guidetti B, Cruccu G, Manfredi M. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the Gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol. Neurosurgery. 1989;24:239–45. https://doi.org/10.1227/00006123-198902000-198900014.
Montano N, Ioannoni E, Rapisarda A. The risk of mastication weakness after percutaneous balloon compression for the treatment of trigeminal neuralgia. Clin Neurol Neurosurg. 2020;195:105880. https://doi.org/10.1016/j.clineuro.2020.
Unal TC, Unal OF, Barlas O, Hepgul K, Ali A, Aydoseli A, Aras Y, Sabanci PA, Sencer A, Izgi N. Factors determining the outcome in trigeminal neuralgia treated with percutaneous balloon compression. World Neurosurg. 2017;107:69–74. https://doi.org/10.1016/j.wneu.2017.1007.1132. Epub 2017 Jul 30.
Yadav S, Sonone RM, Jaiswara C, Bansal S, Singh D, Rathi VC. Long-term follow-up of trigeminal neuralgia patients treated with percutaneous balloon compression technique: a retrospective analysis. J Contemp Dent Pract. 2016;17:263–6. https://doi.org/10.5005/jp-journals-10024-11838.
Bergenheim AT, Asplund P, Linderoth B. Percutaneous retrogasserian balloon compression for trigeminal neuralgia: review of critical technical details and outcomes. World Neurosurg. 2013;79:359–68. https://doi.org/10.1016/j.wneu.2012.1003.1014. Epub 2012 Apr 2.
Chen JF, Tu PH, Lee ST. Long-term follow-up of patients treated with percutaneous balloon compression for trigeminal neuralgia in Taiwan. World Neurosurg. 2011;76:586–91. https://doi.org/10.1016/j.wneu.2011.1005.1021.
De Cordoba JL, Garcia Bach M, Isach N, Piles S. Percutaneous balloon compression for trigeminal neuralgia: imaging and technical aspects. Reg Anesth Pain Med. 2015;40:616–22. https://doi.org/10.1097/AAP.0000000000000292.
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Zhong, J. (2023). The Key to a Successful PBC in Treatment of Trigeminal Neuralgia. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_26
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DOI: https://doi.org/10.1007/978-3-031-36084-8_26
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