Percutaneous balloon compression (PBC) of trigeminal ganglion for recurrent trigeminal neuralgia after microvascular decompression (MVD)

Background Although microvascular decompression (MVD) has become the best surgical treatment for trigeminal neuralgia, it does not achieve 100 % cure rate. Re-exploration of the posterior fossa may carry increased risk over first-time MVD and is not always successful, so other treatments are needed. Aims In this study, we evaluate the effectiveness of the patients with recurrent trigeminal neuralgia after MVD treated with percutaneous balloon compression (PBC). Methods The clinical data of 52 recurrent trigeminal neuralgia patients after MVD who underwent PBC between November 2007 and March 2012 were retrospectively reviewed and analyzed. Results After the PBC, 50 patients (96.2 %) experienced immediate pain relief; 1 patient had occasional pain, and did not require medication; and 1 patient had no pain relief. The total efficiency was 98.1 %. With a mean length of follow-up of 37.6 months, ranging from 12 to 64 months after surgery, 43 (82.7 %) patients remained pain-free, 4 patients (7.7 %) had mild recurrence, and 3 patients (5.8 %) had severe recurrence. The mean time to recurrence was 25.1 months (5-60 months). PBC was repeated a second time in three patients, a third time in one patient. Postoperative complications included facial numbness in 51 patients (98.1 %), masseter muscle weakness in 31 patients (59.6 %), paresthesia in 5 patients (9.6 %), and diplopia secondary to abducens nerve palsy in 1 patient (1.9 %). None of the patients had serious surgical morbidities. Conclusions PBC is a minimally invasive, safe and effective procedure which can be regarded as an optimized choice for recurrent trigeminal neuralgia after MVD.