Multivariate models to predict pain recurrence and sensitive complications after percutaneous balloon compression in trigeminal neuralgia

Antoine KourilskyDepartments of Neurosurgery,

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 MD, MSc
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Clément PalpacuerClinical Research and Biostatistics, and

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Alister RogersDepartments of Neurosurgery,

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Dorian ChauvetDepartments of Neurosurgery,

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Catherine WiartPain Assessment and Treatment, Hospital Fondation Adolphe de Rothschild, Paris, France; and

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Pierre BourdillonDepartments of Neurosurgery,
Harvard Medical School, Harvard University, Boston, Massachusetts

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Caroline Le GuérinelDepartments of Neurosurgery,

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OBJECTIVE

Percutaneous balloon compression (PBC) is a popular treatment option for trigeminal neuralgia. However, the efficacy of PBC is widely considered to be associated with the occurrence of sensitive complications, although neither this correlation nor the underlying mechanisms have been established. The objectives of the present study were to identify factors predicting time to pain recurrence after PBC and identify factors predicting a severe sensitive complication.

METHODS

The authors conducted a retrospective study on patients who underwent PBC for the first time between 1985 and 2019 in two French hospitals. Data were retrieved from patients’ medical records. Potential clinical and radiological predictors for time to pain recurrence and severe sensitive complication were evaluated using a Cox model and a logistic regression, respectively.

RESULTS

A total of 131 patients were included in the study, with a median follow-up of 3.0 years. Pain recurrence occurred in 77 patients, and the median time to pain recurrence was 2.0 years. In the multivariate analysis, six independent factors predicting pain recurrence were identified: 1) longer duration of presurgical symptoms; 2) localization of the pain along the mandibular branch of the trigeminal nerve (V3); 3) atypical pain; 4) diagnosis of multiple sclerosis; 5) use of a medical device not specifically adapted for trigeminal neuralgia surgery; and 6) duration of balloon compression > 60 seconds. Regarding the secondary objective, 26 patients presented a severe sensitive complication after PBC, which the authors defined as the development of a new sensitivity disorder of the cornea, deafferentation pain known as anesthesia dolorosa, and/or long-lasting hypoesthesia augmentation characterized by the new appearance or increase in size or intensity of an area of hypoesthesia in the face for at least 3 months. The only predictor associated with a severe sensitive complication in the multivariate analysis was compression duration > 60 seconds.

CONCLUSIONS

These results show that the risk of postoperative complications can be assessed at the patient level, the most important modifiable parameter being the time of compression by the balloon. Although this study shows the relevance of a personalized medicine approach, its clinical application remains to be validated.

ABBREVIATIONS

AIC = Akaike information criterion; MS = multiple sclerosis; MVD = microvascular decompression; PBC = percutaneous balloon compression; ROC = receiver operating characteristic.
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Illustration from Xu et al. (pp 1418–1430). With permission from Juan Carlos Fernandez-Miranda and The Neurosurgical Atlas by Aaron Cohen-Gadol.

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