Balloon Compression Rhizolysis in the Surgical Management of Trigeminal Neuralgia

Abstract

To overcome some of the disadvantages of the current percutaneous surgical approaches to trigeminal neuralgia, we offer balloon compression rhizolysis (BCR) as an alternative. Guided by fluoroscopy, a 4 French Fogarty catheter is introduced into Meckl's cave, and its balloon is inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion and rootlets, under light endotracheal anesthesia. All patients experience immediate pain relief, with mild numbness in all three divisions, but with corneal sparing. Often, weakness of ipsilateral mastication appears transiently. In 33 procedures performed in 25 patients aged 48 to 86, with a follow-up period of 6 months to 7 years, there were 25 long-lasting cures (76%) and 8 recurrences. These results are fully comparable to those of other "destructive" procedures. There was no anesthetic complication and no mortality. The The advantages of this procedure, besides its efficacy and low rate of dysesthesia, include absence of discomfort for the patient, short operative time, technical ease for the neurosurgeon, minimal morbidity, and no risk to corneal sensation. We think that microvascular decompression (MVD) should be the first operation considered for trigeminal neuralgia, but we BCR as the procedure of choice in the aged and medically infirm, especially when V1 pain is present, in patients with multiple sclerosis, for recurrences after other procedures, and in virtually any situation in which MVD is, for some reason, not feasible.

Percutaneous balloon compression of the trigeminal nerve for treatment of trigeminal neuralgia

“…Mullan [17] reported a 28% recurrence rate after 1 to 10 years of follow-up study. Belber and Rak [3] had a 24% recurrence rate at 6 months to 7 years of follow-up evaluation. Fraioli, et al, [7] had a 9.8% recurrence rate at 3.5 years of follow up.…”

“…After induction of anesthesia, an external pacemaker is placed and set to trigger at 45 beats/minute should bradycardia occur during balloon compression, which it does in two of three patients. Belber and Rak [3] blocked the trigeminal depressor response that occurs with administration of pre-and intraoperative atropine. This depressor response consists of both bradycardia and brief hypotension, often with reflexive hypertension after triggering the pacemaker (Fig.…”

1. Trigeminal Neuralgia

“…Although there are insufficient good qualitative data, this technique, with regard to efficacy, appears to be comparable with percutaneous RF treatment of Gasserian ganglion. The advantage of this technique is that it is also suitable for treatment of trigeminal neuralgia of the first branch, allowing the corneal reflex to remain intact 14,19 …”

Analysis of Occlusal Stresses Transmitted to the Inferior Alveolar Nerve by Multiple Threaded Implants

“…30 Information about trigeminal reaction to local applied pressure is shown by the compressive technique performed with stents applied transcutaneously, close to the oval foramen used to control neuralgias of the trigeminal nerve. [31][32][33][34][35][36] Pressures >100 to 200 mmHg applied for 30 to 60 seconds to the trigeminal nerve can cause a block of nervous transmission and, in the neuralgias, solve the pain problem. 30,34 Studies have reported alteration of mandibular nerve sensibility following implant placement.…”