Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring

Jeffrey A. Brown M.D. and Julie G. Pilitsis M.D., Ph.D.
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  • Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, Michigan
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Object

Percutaneous balloon compression is an effective and technically simple method for treating trigeminal neuralgia (TN). Nevertheless, dysesthesias (10–20%) and masseter muscle weakness (66%) following the procedure have been noted. The purpose of this study was to evaluate the results of testing TN with percutaneousballoon compression aided by intraluminal pressure monitoring.

Methods

In this study the authors review the results and complications associated with percutaneous balloon compression by using intraluminal pressure monitoring data obtained in 65 procedures performed in 56 consecutive patients over 4 years. The mean patient age was 71 years (range 37–92 years), and the mean follow-up duration was 17 months (range 3–38 months). The mean intraluminal compression pressure was (1160 ± 62 mm Hg), and the mean duration of compression was 1.15 ± 0.27 minutes. The trigeminal depressor response was observed in 60 (92%) of 65 procedures, and initial pain relief occurred in 92% of patients. The recurrence rate in patients who had initial relief was 16% (nine of 56). The mean time until recurrence in patients who experienced pain relief after surgery was 13 months (range 3–23 months). Mild numbness immediately after surgery was observed in 83% of patients. At the most recent evaluation, 17% of patients reported persistent, nontroublesome numbness and none had moderate or severe numbness. Minor dysesthesia was present in two patients (4%). Mild masseter muscle weakness occurred in 24% of patients and resolved within a maximum period of 1 year. No patient experienced anesthesia dolorosa, corneal keratitis, or other cranial nerve deficits. These morbidity rates are lower than the incidence reported in the literature when pressure monitoring is not used.

Conclusions

These data show that by monitoring compression pressure and limiting the duration of compression, it is possible to reduce the incidence of dysesthesias, severe numbness, and masseter weakness after surgery without increasing the rate of recurrent pain in patients with classic TN.

Abbreviations used in this paper:MR = magnetic resonance; TN = trigeminal neuralgia.

Object

Percutaneous balloon compression is an effective and technically simple method for treating trigeminal neuralgia (TN). Nevertheless, dysesthesias (10–20%) and masseter muscle weakness (66%) following the procedure have been noted. The purpose of this study was to evaluate the results of testing TN with percutaneousballoon compression aided by intraluminal pressure monitoring.

Methods

In this study the authors review the results and complications associated with percutaneous balloon compression by using intraluminal pressure monitoring data obtained in 65 procedures performed in 56 consecutive patients over 4 years. The mean patient age was 71 years (range 37–92 years), and the mean follow-up duration was 17 months (range 3–38 months). The mean intraluminal compression pressure was (1160 ± 62 mm Hg), and the mean duration of compression was 1.15 ± 0.27 minutes. The trigeminal depressor response was observed in 60 (92%) of 65 procedures, and initial pain relief occurred in 92% of patients. The recurrence rate in patients who had initial relief was 16% (nine of 56). The mean time until recurrence in patients who experienced pain relief after surgery was 13 months (range 3–23 months). Mild numbness immediately after surgery was observed in 83% of patients. At the most recent evaluation, 17% of patients reported persistent, nontroublesome numbness and none had moderate or severe numbness. Minor dysesthesia was present in two patients (4%). Mild masseter muscle weakness occurred in 24% of patients and resolved within a maximum period of 1 year. No patient experienced anesthesia dolorosa, corneal keratitis, or other cranial nerve deficits. These morbidity rates are lower than the incidence reported in the literature when pressure monitoring is not used.

Conclusions

These data show that by monitoring compression pressure and limiting the duration of compression, it is possible to reduce the incidence of dysesthesias, severe numbness, and masseter weakness after surgery without increasing the rate of recurrent pain in patients with classic TN.

Abbreviations used in this paper:MR = magnetic resonance; TN = trigeminal neuralgia.

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Contributor Notes

Address reprint requests to: Jeffrey A. Brown, M.D., Neurological Surgery, P.C., 600 Northern Boulevard #118, Great Neck, New York 11021. email: jbrown@med.wayne.edu.

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