Clinical Analysis Of C-arm Guided Balloon Compression For Recurrent Trigeminal Neuralgia

Background and ObjectiveTrigeminal neuralgia is a common cranial nervous system disease with severe facial pain as the main clinical manifestation.There are various treatment methods,each with advantages and disadvantages,and a certain recurrence rate.For the treatment of recurrent trigeminal neuralgia,it is still a difficult problem in the medical field.Currently,there have been no guidelines and no clear recommendations for the treatment of recurrent trigeminal neuralgia.In this study,we summarized the efficacy,complications and recurrence of the treatment of C-arm guided percutaneous microballoon compression for recurrent trigeminal neuralgia,so as to explore the clinical application value and provide a safe and effective method for the treatment of recurrent trigeminal neuralgia.MethodsClinical data of the patients with recurrent trigeminal neuralgia who had accepted PBC treatment were collected,observed and followed up(by telephone or clinic)at the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to February 2019.The short-term and long-term complications were recorded.And the general clinical characteristics,surgical efficacy,complications and follow-up results were statistically analysed.Results1.A total of seventy-five recurrent trigeminal neuralgia patients treated with PBC were included,among whom there were sixty-nine patients experiencing cure including sixty-five cases with significantly immediate cure and four cases with delayed cure.In these patients with delayed cure,3 patients with delayed cure occurred in one week and 1 patient occurred in two weeks,respectively.One case was markedly effective.In this case,it was too difficult to puncture as result that the patient’s foramen ovale was mutated and the position of the balloon catheter was not ideal.The balloon shape presented pear-like shape and the rupture was intraoperative twice in the operation.Three patients with atherosclerosis showed effective,one of whom had received MVD treatment twice and percutaneous radiofrequency thermocoagulation once before,one of whom had received percutaneous radiofrequency thermocoagulation and local occlusion treatment and the other of whom had received local occlusion therapy.Two patients had no effect,who had received multiple radiofrequency thermocoagulation therapy.Seventy-five patients with recurrent trigeminal neuralgia had a total effective rate of 97.33%after receiving PBC treatment.With a year of follow-up,one patient with trigeminal neuralgia secondary to acoustic neuroma experenced a relapse.The patient had pain relief after craniotomy for tumor resection,showing pain recurrence half a year later with ineffective subsequent radiofrequency thermocoagulation therapy.And then the patient had recurrence again after this PBC treatment.In order to alleviate the pain,partial trigeminal nerve dissection was performed by craniotomy with immediate postoperative pain relief.The chi-square test results showed that gender,age,course of disease,side,location of pain distribution,and previous treatment had no significant correlation with the postoperative efficacy of PBC(P>0.05).There was a statistically difference between balloon morphology and PBC postoperative efficacy(χ~2=44.429,P<0.001).2.In all seventy-five recurrent trigeminal neuralgia patients,there were sixty-five(86.7%)patients with surgical facial numbness,among whom there were fifty-three cases showed moderate facial numbness.With the prolongation of follow-up after PBC,facial numbness was significantly improved or well tolerated.The results of facial numbness after the operation were as follow,at 3 months,a total of 67 patients(89.3%)had no facial numbness or moderate facial numbness,among whom 6 had mild facial numbness discomfort and 2 had severe facial numbness discomfort.At 6months,the total number of patients with no facial numbness and moderate facial numbness was 72 cases(96%),among whom 3 cases had mild facial numbness discomfort and 0 case had severe facial numbness discomfort.There were forty-two patients(56%)with trigeminal nerve inhibitory reflex,among whom two patients had transient cardiac arrest during the operation,and both of them returned to normal status after the operation.Preoperative routine application of atropine can significantly reduce the occurrence of trigeminal nerve inhibitory reflex.The incidence of herpes simplex in 18 patients(24%)treated with prophylactic acyclovir after surgery was significantly lower than that of non-users.There were twenty-nine cases with masticatory muscle weakness,which recovered gradually in six or eight months.There were four cases with diplopia,which returned to normal status within two weeks.There were 5 patients with hypopnea after PBC,which can return to normal by eye drops and other symptomatic treatment within one month.Perioperative herpes,facial swelling,headache were returned to normal by other symptomatic treatment within 1 to 2 weeks,and no serious fatal or disabling complications occurred.The average operation and inhospital time was 37.61±16.54minutes and 4.65±1.45 days,respectively.ConclusionC-arm guided PBC is a minimally invasive,safe and effective method for the treatment of recurrent trigeminal neuralgia,which can be an ideal choice for recurrent trigeminal neuralgia.