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Objective:There are a variety of minimally invasive interventional treatments for trigeminal neuralgia,and the efficacy evaluation is different.The preferred treatment scheme is still controversial.This study aims to investigate the differences in treatment effects between patients with primary trigeminal neuralgia(PTN)treated with percutaneous balloon compression(PBC)for the first intervention and patients with pain recurrence after radiofrequency thermocoagulation(RT)who then received PBC for PTN,and to offer clinicians and patients more scientifically grounded and precise treatment alternatives. Methods:We retrospectively analyzed 103 patients with PTN admitted to the Department of Pain Management of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to December 2021,including 49 patients who received PBC for the first time(PBC group)and 54 patients who received PBC for pain recurrence after RT(RT+PBC group).General information,preoperative pain score,intraoperative oval foramen morphology,oval foramen area,balloon volume,duration of compression,and postoperative pain scores and pain recurrence at each time point on day 1(T1),day 7(T2),day 14(T3),1 month(T4),3 months(T5),and 1 year(T6)were collected and recorded for both groups.The differences in treatment effect,complications and recurrence between the 2 groups were compared,and the related influencing factors were analyzed. Results:The differences of general information,preoperative pain scores,foramen ovale morphology,foramen ovale area,T1 to T3 pain scores between the 2 groups were not statistically different(all P>0.05).The balloon filling volume in the PBC group was smaller than that in the RT+PBC group,the pain scores at T4 to T6 and pain recurrence were better than those in the RT+PBC group(all P<0.05).Pain recurrence was positively correlated with pain scores of T2 to T6(r=0.306,0.482,0.831,0.876,0.887,respectively;all P<0.01). Conclusion:The choice of PBC for the first intervention in PTN patients is superior to the choice of PBC after pain recurrence after RT treatment in terms of treatment outcome and pain recurrence.
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Objective:To explore the clinical efficacy and safety analysis of a novel laser localization technology assisted percutaneous puncture of trigeminal nerve microsphere capsule compression surgery for the treatment of primary trigeminal neuralgia.Methods:A retrospective selection was conducted on 63 patients with primary trigeminal neuralgia who underwent percutaneous puncture of the trigeminal nerve microsphere capsule compression surgery at the First Hospital of Hunan University of Chinese Medicine from January 2020 to December 2021. According to different surgical methods, they were divided into a new laser localization assisted puncture group (observation group) of 32 cases and a traditional barehanded localization puncture group (control group) of 31 cases. An analysis was conducted on the surgical time, puncture time, puncture frequency, intraoperative exposure to radiation, number of cases of poor balloon formation, and clinical efficacy within 6 months after surgery for two groups of patients. The prognosis of the patients was followed up at 6 months after surgery.Results:The surgical time, puncture time, puncture frequency, and intraoperative exposure of the observation group were all less than those of the control group, and the differences were statistically significant (all P<0.05). There was no statistically significant difference ( P>0.05) in the number of cases of poor balloon angioplasty between the observation group and the control group, as well as the pain score grading of the Barlow Neurological Institute (BNI) on the first day after surgery. Within 6 months after surgery, there was no statistically significant difference in the incidence of facial numbness, diplopia, masseter weakness, perilabial herpes, and recurrent pain between the two groups of patients (all P>0.05). Conclusions:Laser positioning technology can assist in precise puncture of the foramen ovale and accurate placement of balloons based on surgical experience, which helps to improve surgical safety, reduce postoperative complications and intraoperative radiation dose, and achieve satisfactory short-term follow-up results.
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Objective:To investigate the efficacy of percutaneous balloon compression (PBC) in the treatment of trigeminal neuralgia (TN) and the risk factors of postoperative recurrence.Methods:A retrospective case-control study was conducted to collect the clinical data of 200 TN patients admitted to Hebei General Hospital from February 2018 to February 2019. According to different treatment methods, the patients were divided into operation group ( n=150) and conservative group ( n=50). The operation group received PBC treatment, and the conservative group received conservative treatment. The clinical efficacy of the two groups was recorded, including total effective rate, VAS, quality of life score (physical function, health status, social function, mental health). Patients treated with PBC were followed up for 4 years, and were divided into relapse group ( n=23) and non-recurrence group ( n=127) according to postoperative recurrence. The baseline data and laboratory indexes of the two groups were recorded, including fasting blood glucose, procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α). Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups. Chi-square test was used for comparison between count data groups. The factors related to postoperative recurrence of TN patients were first analyzed by univariate analysis, and then by multivariate Logistic regression analysis. A nomogram prediction model was constructed to predict postoperative recurrence, and its prediction efficiency was evaluated. The model was stratified by X-tile software to discuss its clinical application value. Results:The total effective rate, VAS of the operation group were 94.00%, 2.14±0.57, the conservative group were 78.00%, 3.87±1.16, and the difference between the two groups was statistically significant ( P< 0.05). The scores of physical function, health status, social function and mental health of quality of life in the operation group after treatment were 89.75±4.67, 90.36±5.68, 87.68±4.16, 88.79±5.09, the conservative group were 82.54±4.03, 84.67±4.28, 81.45±4.09, 80.69±4.89, and the difference between the two groups was statistically significant ( P< 0.05). Of 150 patients treated with PBC, 23 (15.33%) relapsed. Hypertension( OR=2.537, 95% CI: 1.069-6.019), diabetes( OR=5.179, 95% CI: 1.492-17.970), hyperlipidemia( OR=2.447, 95% CI: 1.227-4.883), CRP≥6.62 mg/L( OR=6.386, 95% CI: 1.738-9.854), IL-6≥19.55 ng/L( OR=8.028, 95% CI: 1.279-12.214), procalcitonin ≥1.13 ng/mL ( OR=7.615, 95% CI: 5.020-14.559), TNF-α≥4.56 ng/L( OR=6.226, 95% CI: 4.950-13.337) were independent risk factors for postoperative recurrence of PBC ( P<0.05). Based on the nomogram constructed by the above 7 risk factors, the decision curve showed that the net benefit rate was greater than 0 when the threshold probability was between 0.01 and 0.91. The X-tile software was used to divide the model into three levels of low (>21.6), medium (13.8-21.6) and high (<13.8) risk according to the Logistic risk score, and the postoperative recurrence probability of PBC was 10.87%, 20.74% and 64.04%, respectively. The recurrence rate of PBC in the high-risk group was significantly higher than that in the medium-risk group and the low-risk group ( χ2=5.136, P=0.015). Conclusions:Percutaneous balloon compression of trigeminal nerve in the treatment of patients with trigeminal neuralgia has the advantages of high total effective rate, fewer postoperative complications, good clinical efficacy, quick effect and so on. The construction of percutaneous balloon compression of trigeminal nerve in patients with trigeminal neuralgia postoperative recurrence risk prediction model to provide reference for clinical improvement of patient rehabilitation.
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Objective:To investigate the clinical efficacy of trigeminal neuralgia treatment in elderly patients with percutaneous balloon compression assisted by a robotic surgical navigation and positioning planning system.Methods:Eleven elderly patients with trigeminal neuralgia admitted to the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University between August 2021 and August 2022 were retrospectively analyzed.Three-dimensional time-of-flight magnetic resonance angiography, a three-dimensional fast spin-echo sequence with variable flip angles and thin-slice CT scans were performed before the procedure, and multimodal image fusion was performed by a robot workstation.The volume of Meckel's cave was calculated.Two paths were set up in the surgical planning: an actual puncture path, targeting the anterior inner quadrant of the internal foramen ovale, and a virtual path, used to plan the insertion depth of the balloon.The actual puncture path was completed under the guidance of the robotic arm adapter, and the virtual path for depth measurement was completed under lateral X-ray views of digital subtraction angiography.The balloon was placed at the predetermined depth and was inflated to form a pear shape to complete the procedure.The visual analogue scale(VAS)score was used to evaluate preoperative pain, and the Barrow Neurological Institute(BNI)facial numbness score was used to evaluate postoperative facial numbness.The patients were followed up for 1-12 months and the results were analyzed.Results:In all of the 11 patients, puncturing the foramen ovale and entry into the Meckel's cave were successfully conducted and the balloon was inflated to form a pear shape.Ten patients(90.9%)achieved complete remission immediately after the procedure, and 1 patient had delayed healing at 5 days after the procedure.There were no serious complications related to the procedure.There was no recurrence of pain during the follow-up, and the BNI numbness grading was between 2-3.The ratio between the inflated balloon volume and the preoperative volume of the Meckel's cave was approximately 1.7.Conclusions:Robot-assisted percutaneous balloon compression is safe and effective for the treatment of trigeminal neuralgia in elderly patients.
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OBJECTIVES@#Primary trigeminal neuralgia (PTN) is a common cranial nerve disease in neurosurgery, which seriously endangers the physical and mental health of patients. Percutaneous balloon compression (PBC) has become an effective procedure for the treatment of PTN by blocking pain conduction through minimally invasive puncture. However, the recurrence of facial pain after PBC is still a major problem for PTN patients. Intraoperative balloon shape, pressure and compression time can affect the prognosis of patients with PBC after surgery. The foramen ovale size has an effect on the balloon pressure in Meckel's lumen. This study aims to analyse the predictive value of foramen ovale size for postoperative pain recurrence of PBC by exploring the relationship between foramen ovale size and postoperative pain recurrence of PBC.@*METHODS@#A retrospectively analysis was conducted on the clinical data of 60 patients with PTN who were treated with PBC in Department of Neurosurgery, Affiliated Hospital of Chengde Medical College from November 2018 to December 2021. We followed-up and recorded the Barrow Neurological Institute (BNI) pain score at 1, 3, 6 and 12 months after operation. According to the BNI pain score at 12 months after surgery, the patients were divided into a cure group (BNI pain score I to Ⅱ) and a recurrence group (BNI pain score Ⅲ to Ⅴ). The long diameter, transverse diameter and area of foramen ovale on the affected side and the healthy side of the 2 groups were measured. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used for analysis the relationship between the recurrence of pain and the long diameter, transverse diameter, area of foramen ovale on the affected side, and aspect ratio, transverse diameter ratio, area ratio of foramen ovale on the affected side to healthy side in the 2 groups.@*RESULTS@#At the end of 12 months of follow-up, 50 (83.3%) patients had pain relief (the cured group), 10 (16.7%) patients had different degrees of pain recurrence (the recurrence group), and the total effective rate was 83.3%. There were no significant differences in preoperative baseline data between the 2 groups (all P>0.05). The long diameter of foramen ovale on the affected side, the long diameter ratio and area ratio of foramen ovale on the affected/healthy side in the cured group were significantly higher than those in the recurrence group (all P<0.05), and there were no significant differences in the transverse diameter and area of foramen ovale on the affected side and the transverse diameter ratio of foramen ovale on the affected/healthy side between the 2 groups (all P>0.05). The ROC curve analysis showed that the AUC of the long diameter of foramen ovale on the affected side was 0.290 (95% CI 0.131 to 0.449, P=0.073), and the AUC of aspect ratio of foramen ovale on the affected side to healthy side was 0.792 (95% CI 0.628 to 0.956, P=0.004). The AUC of area ratio of foramen ovale on the affected side to healthy side was 0.766 (95% CI 0.591 to 0.941, P=0.008), indicating that aspect ratio and area ratio of foramen ovale on the affected side to healthy side had a good predictive effect on postoperative pain recurrence of PBC. When aspect ratio of foramen ovale on the affected side to healthy side was less than 0.886 3 or area ratio of foramen ovale on the affected side to healthy side was less than 0.869 4, postoperative pain recurrence was common.@*CONCLUSIONS@#Accurate evaluation of the foramen ovale size of skull base before operation is of great significance in predicting pain recurrence after PBC.
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Humans , Retrospective Studies , Foramen Ovale , Treatment Outcome , Trigeminal Neuralgia/surgery , Pain, Postoperative/etiology , RecurrenceABSTRACT
Objective:To investigate the changing characteristics and stages of balloon pressures in treatment of trigeminal neuralgia by percutaneous balloon compression (PBC), and explore the relations of balloon pressures at different stages with postoperative facial numbness and pain recurrence.Methods:A prospective analysis was performed. Thirty-two patients with primary trigeminal neuralgia, admitted to our hospital from May 2019 to May 2020, were chosen. During surgery, a manometer was connected with computer manometry software to continuously monitor the balloon pressure changes; pear-shaped stage and maintenance stage were named during the balloon pressure changes. The facial numbness occurrence and pain recurrence were assessed by Barrow Institute of Neurology (BNI) facial numbness and pain intensity scales. Robust evaluation method referred to American Institute for Clinical and Laboratory Standardization (CLSI) C28-A2 document was used to determine the reference ranges of balloon pressures at the pear-shaped stage, maintenance stage and whole-process stage (pear-shaped stage+maintenance stage). Spearman rank correlation test was used to analyze the correlations of balloon pressures at the pear-shaped stage, maintenance stage and whole-process stage with facial numbness 24 h and 12 months after surgery, and pain recurrence 6 and 12 months after surgery.Results:Among the 32 patients, pain relief was found in 31 patients and lateral numbness was found in 30 patients 24 h after surgery. Pain recurred 12 months after surgery in 2 patients. The reference ranges of pressure at pear-shaped stage, maintenance stage and whole-process stage were (157.2-128.5) kPa, (136.10-117.9) kPa and (141.9-119.9) kPa, respectively. The pressures at pear-shaped stage, maintenance stage and whole process stage were positively correlated with facial numbness 24 h and 12 months after surgery ( P<0.05); there were negative correlations between pressures at pear-shaped stage and whole-process stage and pain recurrence 6 months after surgery ( P<0.05); pressures at pear-shaped stage, maintenance stage and whole-process stage were negatively correlated with pain recurrence 12 months after surgery ( P<0.05). Conclusion:The lower the balloon pressure during PBC, the more likely it would have pain recurrence after surgery; and the higher the pressure, the more likely it would have facial numbness after surgery; the efficacy of PBC can be maximized when the balloon pressures maintains at adequate ranges ([157.2-128.5] kPa at the pear-shaped stage, [136.1-117.9] kPa at the maintenance stage and [141.9-119.9] kPa at the whole-process stage).
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Objective:To investigate the influences of morphological characteristics of skull base ovale foramen in the puncture difficulty of percutaneous balloon compression (PBC), surgical efficacy and postoperative complications in patients with idiopathic trigeminal neuralgia (ITN).Methods:One hundred and twenty-seven patients with ITN, admitted to our hospital from January 2020 to January 2021, were collected. Dyna-CT three-dimensional imaging of the oval foramen at the skull base and PBC treatment were performed on the included patients, and the morphological data of the oval foramen were measured. Numeric Rating Scale (NRS) was used to assess pain degrees before and after surgery. The differences of cross-sectional area and exposure Angle, puncture difficulty and time, NRS scores before and after surgery and incidence of complications were compared in patients with ovale foramen at different forms. The correlations of puncture time with puncture difficulty and cross-sectional area of ovale foramen in skull base were analyzed.Results:The foramen ovale in skull base of 127 patients included standard oval shape ( n=82), almond shape ( n=9), narrow and long shape ( n=13), fissure shape ( n=8) and irregular shape ( n=15). Different morphological characteristics of the skull base ovale foramen could lead to significant differences in the difficulty of puncture, exposure angle, cross-sectional area and puncture time ( P<0.05). Puncture time was positively correlated with puncture difficulty and cross-sectional area ( r=0.359, P<0.001; r=0.280, P=0.007). The patients with skull base ovale foramen of different forms showed no significant differences in the differences of NRS scores before and after PBC and occurrence of postoperative complications ( P>0.05). Conclusion:Dyna-CT three-dimensional imaging can visually display the morphological characteristics of the oval foramen at the skull base; this technique can be used to guide the puncture of the oval foramen and effectively evaluate the difficulty of puncture in PBC, but it does not affect the postoperative pain improvement and complication incidences.
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Introducción: Introducción: La compresión percutánea con balón (CPB) es una de las técnicas estándar para el tratamiento de la neuralgia del trigémino. El objetivo de este estudio es evaluar la eficacia de la compresión percutánea con balón (CPB) del ganglio de Gasser y raíz trigeminal en el tratamiento de la neuralgia del trigémino (TN). Métodos: Se usó un estudio observacional analítico de cohorte prospectivo. Un total de 293 pacientes con neuralgia del trigémino fueron tratados con la CPB entre octubre de 2008 y octubre de 2019 en Lima, Perú. Los datos fueron obtenidos de los registros hospitalarios y entrevistas. La CPB se realizó bajo sedación con propofol y remifentanilo. Se administróoxígeno a través de cánula nasal y se monitorizó la frecuencia cardíaca y la presión arterial durante todo el procedimiento. Elprocedimiento se realizó usando fluoroscopia con arco en C para facilitar la introducción de la aguja 14 G hasta que se ingresaal agujero oval y la visualización del catéter Fogarty 4F inflado en el cavum de Meckel. En la posición correcta, generalmenteaparece claramente definido una forma de pera o de reloj de arena después de la inyección de 0.5-1 ml de material decontraste. Resultados: La edad media fue de 64.2 años (rango 27-90). Treinta y seis pacientes (12%) tuvieron otros procedimientosquirúrgicos previos. Doscientos sesenta y dos pacientes (89.4%) experimentaron un alivio inmediato de la neuralgia despuésdel procedimiento. Se obtuvo un balón con forma de pera en 162 casos (55.3%), reloj de arena 73 (24.9%) y oval 58 (19.8%). En 245 pacientes (83.6%) el balón se mantuvo inflado durante 60 - 90 segundos. Es crucial obtener una forma de pera o de reloj de arena porque este es probablemente el factor más importante para obtener un buen alivio del dolor y duradero. Todo el procedimiento dura unos 15 minutos. La hipoestesia hemifacial después del procedimiento fue moderada o severa en el 76.5% de los pacientes. A los tres meses, la mayoría de los pacientes tienen una recuperación significativa en la sensibilidad facial, que continúa recuperándose con el tiempo. Todos los pacientes tuvieron alguna dificultad transitoria para masticar en el lado afectado. Se observó recurrencia en 26 pacientes (9.2%) en un tiempo de seguimiento de 6 meses a 11 años (5.75 años). La forma más común de balón asociada con recurrencia fue la oval (65.4%).Conclusiones: La CPB es técnicamente simple, bien tolerada por los pacientes. La tasa de éxito de la operación es alta. Los pacientes con balón en forma de pera o de reloj de arena obtuvieron los mejores resultados.
Introduction: Percutaneous balloon compression (PBC) is one of the standards techniques for the treatment of trigeminal neuralgia.The objective of this study is to evaluate the efficacy of PBC of the Gasserian ganglion and trigeminal rootlets as treatment for trigeminal neuralgia (TN). Methods: A prospective cohort analytical observational study was used. A total of 293 patients with trigeminal neuralgia were treated with PBC between october 2008 and October 2019 in Lima, Perú. The data were obtained from hospital records and interviews. PBC was performed under sedation with propofol and remifentanil. Oxygen was administered through nasal cannula and the heart rate and blood pressure were monitored throughout the procedure. The procedure is carried out with C-arm fluoroscopy to facilitate the introduction of the 14 G needle until the foramen oval is entered and the visualization of the inflated catheter Fogarty 4F in the Meckel Ìs cave. Once in the right position, a clearly defined pear shape or hourglass is seen after injection of 0.5 1 mL of contrast material. Results: The mean age was 64.2 years (range, 27-90). Thirty-six patients (12%) had other previous surgical procedures. Two hundred sixty-two patients (89.4%) experienced immediate relief from neuralgia following the procedure. A pear-shaped balloon was obtained in 162 cases (55.3%), hourglass 73 (24.9%) and oval 58 (19.8%). In 245 patients (83.6%) the balloon is kept inflated for 6090 seconds. It is crucial to obtain a pear shape or hourglass because this probably is the most significant factor for obtaining good, long-lasting pain relief. The whole procedure takes 15 minutes. Following the procedure, hemifacial hypoesthesia was moderate or severe in 76.5% of patients. Most patients have a significant recovery in facial sensitivity at three months post-procedure and continue to improve over time. All patients faced some transient difficulty chewing in the affected side. Recurrence was observed in 26 patients (9.2%) during a follow-up time of 6 months to 11 years (5.75 years). The most common form of balloon associated with recurrence was oval (65.4%).Conclusions: PBC is a technically simple, well tolerated by patients. The operation success rate is high. Patients with pear or hourglass shape balloon obtained the best results.
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Humans , Trigeminal Neuralgia , Therapeutics , Trigeminal Ganglion , Mastication , NeuralgiaABSTRACT
Objective:To explore the CT three-dimensional reconstruction in percutaneous balloon compression of the semilunar ganglion of trigeminal nerves.Methods:Thirty-one patients with trigeminal neuralgia, admitted to our hospital from May 2018 to August 2018, were treated by percutaneous balloon compression of the semilunar ganglion of trigeminal nerves. All patients underwent intraoperative mobile CT scan; the distance from the external aperture of foramen ovale to the petrous ridge, the angle from puncture needle and the petrous ridge, and the angle from puncture needle and the clivus were analyzed by three-dimensional reconstruction technology. Prognoses were recorded immediately after surgery and 10-12 months after follow-up.Results:The distance from the external aperture of foramen ovale to the petrous ridgea was (2.14±0.17) cm, ranged from 1.83 cm to 2.42 cm. The angle from puncture needle and the petrous ridge was (102.03±7.60)°, ranged from 91.00° to 116.00°. The angle from puncture needle to the clivus was (68.03±7.06)°, ranged from 52.00° to 80.00°. The puncture succeeded in all patients under the help of CT three-dimensional reconstruction. The volume of the inflated balloon ranged from 0.30 cm 3 to 0.47 cm 3 (averaged 0.42±0.05 cm 3). The compression time ranged from 3.00 min to 5.00 min (averaged 4.72±0.53 min). The incidence of diplopia was 3.23%, and the incidence of dry eyes/decreased corneal sensation was 12.90%. During the follow-up, one patient relapsed 10 months after surgery; the left patients recovered with disappeared complications. Conclusion:The CT 3D reconstruction can reduce the difficulty of ovale foramen puncture during operation, assist the judgment and adjustment of intraoperative balloon volume, and improve the surgical efficacy.
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OBJECTIVE: To prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence. METHODS: Prospective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months. RESULTS: After redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p 0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), and annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), and hypoesthesia (5.9%) (p < 0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period. CONCLUSION: For the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.
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Humans , Cohort Studies , Facial Pain , Follow-Up Studies , Herpes Simplex , Hypesthesia , Incidence , Length of Stay , Microvascular Decompression Surgery , Neuralgia , Paresthesia , Prospective Studies , Recurrence , Trigeminal NeuralgiaABSTRACT
OBJECTIVE: To prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence.METHODS: Prospective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months.RESULTS: After redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p < 0.01). Patients who had redo MVD more commonly were pain free off medications (93.4% at 1 year, 78.2% at 4 years) compared with the PBC patients (85.1% at 1 year, 59.3% at 4 years). However, mean length of stay was longer (p>0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), and annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), and hypoesthesia (5.9%) (p < 0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period.CONCLUSION: For the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.
Subject(s)
Humans , Cohort Studies , Facial Pain , Follow-Up Studies , Herpes Simplex , Hypesthesia , Incidence , Length of Stay , Microvascular Decompression Surgery , Neuralgia , Paresthesia , Prospective Studies , Recurrence , Trigeminal NeuralgiaABSTRACT
Summary Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year-old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.
Resumo Osteogênese imperfeita (OI) é uma doença óssea que pode levar a deformidades de base de crânio, como invaginação basilar que pode provocar compressão de nervo craniano, incluindo o nervo trigêmeo. Nestes casos, a neuralgia do trigêmeo permanece como um desafio, pela anatomia distorcida e pelas deformidades. Apresentamos uma alternativa que consiste na canulação do forame oval e no tratamento percutâneo clássico. A microcompressão percutânea por balão foi realizada em uma paciente de 28 anos apresentando OI e grave neuralgia do trigêmeo, sendo realizadas tomografia computadorizada (CT) e canulação guiadas do gânglio gasseriano sem neuronavegação ou dispositivos estereotáxicos. A paciente apresentou hipoestesia à esquerda dos segmentos V1, V2 e V3, com bom controle da dor. Essa técnica alternativa com punção orientada por CT utilizando o angiosuite sem a necessidade de qualquer grampo de Mayfield, sistemas de neuronavegação, ou dispositivos com ou sem arcos estereotáxicos, pode ser uma opção útil, segura e eficiente para pacientes com neuralgia do trigêmeo cursando com outras doenças deformativas que afetem a base craniana de modo grave.
Subject(s)
Humans , Female , Adult , Osteogenesis Imperfecta/surgery , Trigeminal Neuralgia/surgery , Catheterization/methods , Foramen Ovale/surgery , Osteogenesis Imperfecta/diagnostic imaging , Trigeminal Neuralgia/diagnostic imaging , Angiography , Tomography, X-Ray Computed , Reproducibility of Results , Treatment Outcome , Foramen Ovale/diagnostic imagingABSTRACT
Objective To compare clinical outcome of microvascular decompression (MVD) and percutaneous balloon compression (PBC) by using a prospective cohort study in order to provide a reliable evidence for the clinical decision-making. Methods Patients with trigeminal neuralgia hospitalized at Hangzhou First People′s Hospital in 2010 were chosen as database for cohort study. The patients were divided into MVD group (30 cases) and PBC group (30 cases). The clinical efficacy was followed by independent observers for 36 months after surgery. Chi-square test for hierarchical data, t test for quantitative data, and Kaplan-Meier plot for clinical outcomes were applied in the research. The endpoint was follow-up accomplishment or severe occurrence. Results Sixty patients were included in the research till the endpoint. The general records before surgery were almost the same with the literature records. By comparing painless period, mild and severe relapse, MVD group was superior to PBC group (P < 0.05). As for the painless survival period, MVD group was 96.7% of pain free after 1 year, 93.3% after 3 years, while PBC group was 90.0% after 1 year and 83.3% after 3 years. Regarding 3 years of follow-up, the relapse seemed occurred after 1 year in both groups. Conclusions As a curative and nondestructive procedure , MVD is more effective and has longer lasting pain free period , which should be considered as the first choice of treatment for trigeminal neuralgia in healthy people.
ABSTRACT
OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54 percent), the right side of the face (84 percent) and V2V3 roots of trigeminal nerve (33 percent). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80 percent) were pain-free after 50 months with a 90 percent satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.
OBJETIVO: A neuralgia do trigêmeo é a dor facial mais comum. Ela pode ser tratada através da compressão percutânea com balão, que é considerado procedimento seguro e eficaz. A proposta deste estudo foi avaliar nossos resultados e os fatores que influenciariam o seguimento. MÉTODO: Foi utilizada análise multivariada para estudar 39 pacientes submetidos ao procedimento, com seguimento de 50 meses. RESULTADOS: Houve predominância do sexo feminino (54 por cento), lado direito (84 por cento) e dos ramos V2V3 (33 por cento). A idade média foi de 62,3 anos. Não houve complicações maiores ou óbito. Dentre todas as variáveis, a única capaz de influenciar positivamente os resultados foi a hipoestesia pós-operatória (p=0,02). A maioria dos pacientes (80 por cento) estava livre da dor após 50 meses de seguimento, com 90 por cento de satisfação. CONCLUSÃO: Este procedimento foi considerado seguro, com baixa morbidade, sem mortalidade, com alta taxa de aprovação e representou melhora importante na qualidade de vida dos pacientes.
Subject(s)
Female , Humans , Male , Middle Aged , Catheterization , Trigeminal Neuralgia/therapy , Follow-Up Studies , Pressure , Prospective Studies , Treatment OutcomeABSTRACT
Trigeminal neuralgia is sudden, usually unilateral, severe brief stabbing recurrent pain in the distribution of one or more branches of the 5th cranial nerve. Treatments of trigeminal neuralgia include systemic trials of medications and surgical procedures such as microvascular decompression, stereotactic radiosurgery, percutaneous glycerol or alcohol rhizolysis, percutaneous radiofrequency rhizotomy, and percutaneous balloon compression (PBC). PBC of the trigeminal ganglion using a balloon catheter was introduced by Mullan and Lichtor in 1983. Since then, many papers have been published describing results of this technique. Typically, this procedure is performed under general anesthesia. However, little is known about the use of PBC for the treatment of trigeminal neuralgia in Korea. We report here our anesthetic management of percutaneous balloon compression of trigeminal ganglion for the treatment of the trigeminal neuralgia by total intravenous anesthesia.
Subject(s)
Anesthesia, General , Anesthesia, Intravenous , Catheters , Cranial Nerves , Glycerol , Korea , Microvascular Decompression Surgery , Radiosurgery , Rhizotomy , Trigeminal Ganglion , Trigeminal NeuralgiaABSTRACT
OBJECTIVE: We assessed the surgical results of percutaneous balloon compression in 50 patients with idiopathic trigeminal neuralgia. METHODS: Fifty patients with follow-up period of more than 12 months were retrospectively analyzed. The mean follow-up period was 42 months (range, 12-82). The mean age was 65.8 years (range, 27-83). Seventeen patients (34%) had other previous surgical procedures. The balloon was inflated by injecting radio-contrast media under brief general anesthesia according to Mullan's technique. The mean inflating time was 88 seconds (range, 60-120). The whole procedure took about 20 minutes. RESULTS: We reported excellent and good results in 70% of the cases, poor in 6% as annoying dysesthesia, recurrence in 16%, and 8% failure due to technical deficiencies. Forty-six patients (92%) were initially relieved of their pain. There were permanent motor weakness of the masseter muscle in 4% of patients and transitory diplopia in 8%. Neither anesthesia dolorosa nor keratitis occurred. Almost all patients (92%) were discharged postoperatively within two days. CONCLUSION: These results indicate that balloon compression would be an effective method with acceptable morbidity, technically, it can be performed rapidly and simply in the treatment of idiopathic trigeminal neuralgia.