Abstract:Trigeminal neuralgia attacks are among the most painful conditions known. Trigeminal neuralgias are hypothesized to be caused by neurovascular conflict at the trigeminal root entry zone in the prepontine cistern. A range of therapeutic options is available including open surgical microvascular decompression and several percutaneous ablative techniques (eg, radiofrequency rhizotomy and glycerol gangliolysis). Percutaneous balloon compression of the Gasserian retroganglionic rootlets has been reported to have re… Show more
“…10 The compression effect of PBC can be routinely estimated by subjectively observing the shape of the inflated balloon (pear shape), or by empirically controlling the compression time during the operation. [11][12][13][14] However, no objective method has been used to evaluate the extent of compression injury on trigeminal fibers, and the changes in trigeminal nerve conduction after PBC have not been fully elucidated either.…”
Objective: To evaluate the blink reflex (BR) in estimating the potential injury of trigeminal nerve following percutaneous balloon compression (PBC) surgery, and to determine the association between BR alterations and early surgical outcomes.
Methods:In this single-center, prospective before-and-after study, a total of 74 patients who had primary trigeminal neuralgia and scheduled for PBC between October 2020 and June 2021 were prospectively included. BR testing and facial sensory assessment were performed pre-and post-PBC. The latency and the area under the curve (AUC) of pre-and postoperative R1 (R1 pre /R1 post ) and R2 (R2 pre /R2 post ) were measured.
Results:The BR components were noticeably delayed or diminished following PBC.R1 post was elicited in only 26 patients, and absent in 48 patients. The residual R1 post had markedly reduced AUC (median difference [Hodges-Lehmann]: −59.5, 95% confidence interval [CI]: −217.5 to −6.9, p = 0.023). Compared with R2 pre , the latency of R2 post was considerably delayed (mean difference: 4.3, 95% CI: 2.9 to 5.7, p < 0.001) and the AUC was greatly suppressed (median difference [Hodges-Lehmann]: −388.4, 95% CI: −548.4 to −259.5, p < 0.001). After PBC, 58 patients had immediate total pain relief, and 16 had partial relief. The absence of R1 post was found in 46 of 58 (79.3%) patients with complete remission, whereas in only 2 of 16 (12.5%) patients with partial relief. Association analysis showed that the absence of R1 post was strongly associated with total pain relief (46/58 [79.3%] vs. 2/16 [12.5%], odds ratio [OR]: 26.8, 95% CI: 5.4 to 134.5, Cramér's V: 0.6, p < 0.001). The latency of R2 post in patients with total relief was significantly delayed (mean difference: 2.5, 95% CI: 0.3 to 4.6, p = 0.028).Patients experienced graded facial numbness after PBC, of whom 31 reported mild numbness (Grades I-II) and 43 reported more severe numbness (Grades III-IV). The absence of R1 post was significantly associated with facial numbness severity, 33/43
“…10 The compression effect of PBC can be routinely estimated by subjectively observing the shape of the inflated balloon (pear shape), or by empirically controlling the compression time during the operation. [11][12][13][14] However, no objective method has been used to evaluate the extent of compression injury on trigeminal fibers, and the changes in trigeminal nerve conduction after PBC have not been fully elucidated either.…”
Objective: To evaluate the blink reflex (BR) in estimating the potential injury of trigeminal nerve following percutaneous balloon compression (PBC) surgery, and to determine the association between BR alterations and early surgical outcomes.
Methods:In this single-center, prospective before-and-after study, a total of 74 patients who had primary trigeminal neuralgia and scheduled for PBC between October 2020 and June 2021 were prospectively included. BR testing and facial sensory assessment were performed pre-and post-PBC. The latency and the area under the curve (AUC) of pre-and postoperative R1 (R1 pre /R1 post ) and R2 (R2 pre /R2 post ) were measured.
Results:The BR components were noticeably delayed or diminished following PBC.R1 post was elicited in only 26 patients, and absent in 48 patients. The residual R1 post had markedly reduced AUC (median difference [Hodges-Lehmann]: −59.5, 95% confidence interval [CI]: −217.5 to −6.9, p = 0.023). Compared with R2 pre , the latency of R2 post was considerably delayed (mean difference: 4.3, 95% CI: 2.9 to 5.7, p < 0.001) and the AUC was greatly suppressed (median difference [Hodges-Lehmann]: −388.4, 95% CI: −548.4 to −259.5, p < 0.001). After PBC, 58 patients had immediate total pain relief, and 16 had partial relief. The absence of R1 post was found in 46 of 58 (79.3%) patients with complete remission, whereas in only 2 of 16 (12.5%) patients with partial relief. Association analysis showed that the absence of R1 post was strongly associated with total pain relief (46/58 [79.3%] vs. 2/16 [12.5%], odds ratio [OR]: 26.8, 95% CI: 5.4 to 134.5, Cramér's V: 0.6, p < 0.001). The latency of R2 post in patients with total relief was significantly delayed (mean difference: 2.5, 95% CI: 0.3 to 4.6, p = 0.028).Patients experienced graded facial numbness after PBC, of whom 31 reported mild numbness (Grades I-II) and 43 reported more severe numbness (Grades III-IV). The absence of R1 post was significantly associated with facial numbness severity, 33/43
“…The BC approach is recognized as an effective treatment for TN. It has the advantages of minimal trauma, a high effective rate, and a low recurrence rate (28,32,33). Furthermore, its postoperative complications are milder than those of other traumatic operations (10,14,32,33).…”
Background: Balloon compression (BC) is a simple and effective operation to treat trigeminal neuralgia (TN). The most difficult procedure in BC is related to fast and accurate foramen ovale (FO) insertion. In this study, we introduced a new method incorporating a personalized tooth-supported digital guide plate to reduce patient trauma, improve the accuracy and the success rate of insertion, and reduce surgeons' radiation exposure.Methods: In total, 15 TN patients aged 55-70 years were recruited between January 2019 and November 2020 and retrospectively analyzed. Before the operation, based on Mimics 3D reconstruction and the modeling of patients' maxillary teeth, personalized tooth-supported digital guide plates were designed and 3D printed. All operational procedures were simulated. Then, all patients underwent BC with a personalized tooth-supported digital guide plate.Results: In the study, guide plate insertion was completed within 60 seconds for all patients. Puncturing time was limited to 5 seconds. Successful insertion into the FO was achieved in 1 attempt for all 15 participants. No patients required more than 3 postinsertion adjustments to obtain a pear-shaped balloon.There were no postoperative complications, such as cerebrospinal fluid leakage, intracranial infection, or visual acuity change. The trigger points, attack frequency per day, attack duration, and Barrow Neurological Institute (BNI) pain intensity scores of all 15 participants were significantly improved postoperation.The visual analog scale (VAS) score significantly decreased postoperation compared with that obtained preoperation (all P<0.001) and gradually decreased with the extension of follow-up time.Conclusions: By applying a personalized tooth-supported digital guide plate, we can significantly avoid the use of an incision outside the mouth, decrease the difficulty of FO insertion, and reduce patient trauma. The operation is more suitable for novice surgeons and protects surgeons from the harm of radiation. This new technology may improve the success rate and accuracy of FO insertion, although a multicenter, large sample, randomized controlled trial is needed.
“…We preferred modified Härtel’s pathway similar to that described by De Cordoba et al (proposed by Henderson). 8 , 9 Figure 1 Puncture kits and a lateral projection of a PBC surgery. ( A ) PBC Puncture kits.…”
Section: Methodsmentioning
confidence: 99%
“…We preferred modified Härtel's pathway similar to that described by De Cordoba et al (proposed by Henderson). 8,9 On lateral projection, the puncture needle appears between the mandibular condyle and hypophysial fossa. When the blunt-head needle with stylet impacts the cranial bone, the foramen ovale is identified as a soft spot in the bone.…”
Section: Surgical Materials and Puncturing Techniquementioning
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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