Association between Morphological Characteristics of Meckel’s Cave and Outcomes after Percutaneous Balloon Compression for Primary Trigeminal Neuralgia

Abstract

The association between morphological characteristics of Meckel’s cave (MC) and percutaneous balloon compression (PBC) outcomes in patients with primary trigeminal neuralgia (PTN) is still unknown. In this study, a total of 111 patients with PTN who were treated with PBC from January 2019 to February 2023 were included. The affected-sided MCs were modelled using 3D Slicer software, and morphological characteristics were extracted and quantified through the radiomics method. Pain outcomes and post-PBC facial numbness were assessed by an independent surgeon using Barrow Neurological Institute (BNI) pain and numbness grades. Among the 111 patients who underwent PBC, 102 patients (91.9%) experienced significant pain relief at discharge. During the follow-up period, 26 patients (25.5%) experienced a recurrence of pain. Three shape (flatness, elongation, and sphericity) and four size characteristics (major axis length, surface area, volume, and surface volume ratio) were significantly different between patients with favorable and poor outcomes. However, only flatness and volume were finally retained in the multivariable logistic model and found to be predictive of pain outcomes. The areas under the curve of volume, flatness, and their combination for predicting poor outcomes were 0.729, 0.906, and 0.946, respectively. Additionally, 63 patients (56.8%) experienced severe facial numbness after PBC, and small and flat MCs were identified as risk factors for post-PBC severe facial numbness. Further research is required to determine the optimal pressure and duration of balloon compression based on the specific morphological characteristics of MCs in different patient populations.