Macroscopic Effects of Percutaneous Trigeminal Ganglion Compression (Mullan's Technique)

Úrculo, E.; Martínez, Luis Alberto Corona; Arrazola, Mariano; Ramírez, Rafael

doi:10.1227/00006123-199504000-00019

Cited by 25 publications

(14 citation statements)

References 20 publications

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“…Since PBC surgery's inception, neurosurgeons have attempted to generate a pear-shaped balloon ( 2 , 4 , 9 ). Until now, it may have been the only factor influencing the outcome of PBC in TN treatment ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

The pros and cons of multiple puncture in percutaneous balloon compression for treatment of trigeminal neuralgia

et al. 2022

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BackgroundPercutaneous balloon compression (PBC) is an effective and well-established surgery for treating trigeminal neuralgia (TN). However, if the initial attempt fails to produce a distinct pear shape, there is no conventional strategy to follow: repeat a few days later or re-puncture?AimsThis study aimed to analyze the risk and gain of re-puncturation in PBC surgery for TN treatment.MethodsWe reviewed radiographs and medical records from 79 consecutive PBC cases. The complications and surgical outcomes were compared between one-time success pears and multiple re-puncturing pears. Re-puncturing methods included selecting a more appropriate entry point, a more possible entry angle, finding a stretchy spot around the margin of foramen ovale (FO) with a trocar, and exploring the direction with more resistance using a thinner guiding needle.ResultsIn 50% of cases, satisfactory pears were obtained after the first puncture, and in 35% of cases, satisfactory pears were obtained following re-puncturation. Except for hemihypogeusia, which was significantly more in multiple punctures cases (p < 0.05), no additional adverse effects were statistically different between the two groups. There are very few rare complications associated with re-puncturation. Log-Rank test of pain-free rate revealed no statistically significant differences between the two groups (p = 0.129).ConclusionThis study establishes the safety of re-puncturation in PBC surgery for TN treatment. The operation increases pears and does not cause any serious complications. The surgical outcomes of re-puncturation pears are almost identical to those one-time success pears.

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Section: Discussionmentioning

confidence: 99%

The pros and cons of multiple puncture in percutaneous balloon compression for treatment of trigeminal neuralgia

et al. 2022

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“…Neurotransmitter 9 Substanz P 9 Somatostatin Die Atiologie der Trigeminusneuralgie ist nach wie v0r unbekannt. Zahlreiche neuroradiologische [44], neuroanatomische [45,20] und neurochirurgische Befunde [31,39] legen eine periphere Genese des Schmerzes bei der Trigeminusneuralgie nahe. MOgliche Ursachen einer chronischen mechanischen Irritation der Trigeminuswurzel bestehen z.B.…”

Section: Schliisselworterunclassified

Substanz P, Somatostatin und monoaminerge Transmitter in der Zerebrospinalflüssigkeit von Patienten mit chronischer idiopathischer Trigeminusneuralgie

Strittmatter

Grauer

Hamann

et al. 1996

Schmerz

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The etiology of trigeminal neuralgia is unknown, but both peripheral and central causes have been suggested. To investigate the role of central neurochemical mechanisms we measured epinephrine, norepinephrine and their breakdown product, vanilly mandelic acid (VMA), in the cerebrospinal fluid (CSF) of 16 patients (53.3 +/- 8.3 years) suffering from trigeminal neuralgia. As markers for the dopaminergic system, we determined CSF levels of dopamine and its metabolite homovanillic acid (HVA). As a marker for the serotonergic system, we measured CSF levels of serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA). In addition, levels of the neuropeptides substance P and somatostatin were determined. The concentration of norepinephrine (P < 0.01), VMA (P < 0.05) and HVA (P < 0.05) were significantly decreased in patients with trigeminal neuralgia and correlated with the duration of the disease and depression scores. 5-HIAA was also significantly decreased (P < 0.05) compared to control patients. Whereas substance P was significantly elevated (P < 0.05), somatostatin was significantly decreased (P < 0.05). Various correlations between the classical neurotransmitters and the neuropeptides could be established. We hypothesize than the sum of complex neurochemical changes plays a role in the etiology of trigeminal neuralgia, which can be separated in local and more central proceedings. The increase in substance P, a major nociceptive neuromodulator, supports the concept of a local neurogenic inflammation, possibly located in the trigeminovascular system. Depending on the duration of the disease and depression, the loss of serotonergic, dopaminergic and noradrenergic innervation seems to reflect more central changes, possibly due to alterations in their antinociceptive descending pathways.

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“…After Mullan's proposal of the PBC technique, Urculo et al studied the balloon's macroscopic changes on cadavers, providing solid evidence that a good balloon shape is an ideal pear shape in Meckel's cave (MC). 4 Although there are studies about the balloon's shape in PBC surgery, there is no thorough investigation about how and why the balloon shape changes during PBC. [5][6][7] During PBC, inflated balloons may form many shapes other than a typical pear shape.…”

Section: Introductionmentioning

confidence: 99%

The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia

Sun¹,

Zheng²,

Zhu³

et al. 2021

JPR

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Background The pear shape of an inflated balloon is thought to be a gold standard of successful percutaneous balloon compression (PBC). However, neither how nor why it changes in that way (the anatomic basis) has not yet been fully described. Aim In this article, we try to describe how the balloon in Meckel’s cave (MC) should appear and why; and identify which shapes are good pear shapes, which shapes are not good pear shapes, and which shapes are intermediate. Methods Radiographs from over 150 percutaneous balloon compression (PBC) cases were thoroughly evaluated. We proposed a model of changing balloon shape in MC and 70 cases were followed up over two years, in which therapeutic effect was measured. Results We found that the balloon changed stereotypically in MC. The model that we proposed is consistent with the description of MC’s structures and its’ surroundings in the literature. The distinct pear (pear in MC) brought about a far better surgical result than other shapes (p < 0.01). Conclusion Our study showed how and why the balloon shape changed during PBC surgery. The model provides clear guidance for PBC surgery.

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Macroscopic Effects of Percutaneous Trigeminal Ganglion Compression (Mullan's Technique)

Cited by 25 publications

References 20 publications

The pros and cons of multiple puncture in percutaneous balloon compression for treatment of trigeminal neuralgia

The pros and cons of multiple puncture in percutaneous balloon compression for treatment of trigeminal neuralgia

Substanz P, Somatostatin und monoaminerge Transmitter in der Zerebrospinalflüssigkeit von Patienten mit chronischer idiopathischer Trigeminusneuralgie

The Transformation of the Balloon Shape in Percutaneous Balloon Compression for Trigeminal Neuralgia

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