| Objective: Percutaneous Balloon Compression(PBC)is a preferred surgical treatment for trigeminal neuralgia(TN)patients who are elderly,have poor response to oral medication,recurrent pain,or cannot tolerate general anesthesia for craniotomy.Currently,research suggests that balloon shape is one of the important factors affecting the effectiveness of PBC surge ry and postoperative complications.Pear-shaped balloons are a sign of successful surgery.This article first anatomically studies Meckel’s cave(MC)and its surrounding important structures,explores the reasons for different balloon formations,and provi des anatomical evidence for simulating puncture to improve surgical success rate and reduce postoperative complications.In addition,this article analyzes the relationship between different pear-shaped balloons and surgical efficac y and postoperative complications,aiming to provide reference for the clinical application of this technique.Methods: 1.Using formalin-fixed head specimens,relevant data of Meckel’s cave and its adjacent structures were observed and measured.The foramen ovale was divided int o four quadrants: I(medial anterior),II(medial posterior),III(lateral anterior),and IV(lateral posterior).The puncture needle was placed in different quadrants under direct vision,and the balloon was placed in Meckel’s cave to simulate the punctur e process and record the puncture results.2.A retrospective analysis of the clinical data and intraoperative X-ray images of 138 patients with primar y trigeminal neuralgia who underwent PBC treatment in the Department of Neurosurgery from May 2018 to March 2022 was performed.The Image J software was used to measure the ratio of the balloon head to the entire balloon in the image.Based on the ratio size,the balloon was divided into Type A(<10%),Type B(10%-20%),and Type C(>20%).Based on the postoperative follow-up results,the relationship between different pear-shaped balloons during surgery and postoperative efficacy and complications was analyzed.Results: 1.Meckel’s cave is a fissure-like dural sac formed by the crossing of the posterior fos sa dura mater over the petrous apex in the middle cranial fossa,with an average length(12.56±1.14)mm,width(9.17±0.93)mm,and height(4.37±0.85)mm.The sac contains the trigeminal nerve root,trigeminal ganglion,and its branches.It is the target lo cation for placing the balloon in PBC surgery.The success rate of puncture was 75% when the puncture needle was placed in the medial posterior quadrant of the foramen ovale,which was higher than that in the medial anterior quadrant(56%),lateral anterio r quadrant(25%),and lateral posterior quadrant(38%),with statistical significance.2.The pain relief rate of the surger y was 96.9%.There was no significant difference in pain relief rate between different pear-shaped balloons.Typ e B and Type C ballo ons had longer median pain-free time,which was significantly different from that of Type A balloons.There was no significant difference in the duration of numbness caused by different types of pear-shaped balloons,but Type C balloons caused longer durat ion of masticatory muscle weakness.In addition,the compression time and balloon shape also significantly affected the severity of complications.Conclusion: 1.The anatomy of Meckel’s cave and its adjacent structures is crucial for the percutaneous balloon compression procedure.Successful puncture of Meckel’s cave is the key to a successful operation,and the relative position of the balloon in Meckel’s cave is a significant factor in the shape of the balloon.2.Different p ear-shaped balloons have a significant impact on both surgical efficacy and postoperative complications.The smaller the balloon head,the shorter the pain-free time.The larger the head,the longer the masticatory muscle weakness exists and the more severe the complica tions may be.T ype B balloons(10%-20% of balloon head size)seem to be the ideal pear shape.However,its clinical application remains to be validated. |
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