The Exploration And Discussion Of Short-term Efficacy Of Percutaneous Balloon Compression In The Treatment Of Primary Trigeminal Neuralgia

Objective:In this paper,we collected the cases of patients with primary trigeminal neuralgia treated by percutaneous microballoon compression,analyzed the efficacy,related complications and related factors,and discussed the short-term efficacy of this surgery for primary trigeminal neuralgia.Methods:Clinical data were collected from 211 patients with primary trigeminal neuralgia admitted to the Neurosurgery Department of the First Affiliated Hospital of Kunming Medical University from September 2018 to December 2020.The postoperative and intraoperative efficacy of the patients and related complications were analyzed.According to the postoperative efficacy of the patients,the factors such as age,gender,pain distribution area,length of disease course,previous surgical history,difficult puncture and balloon shape were statistically analyzed.Results:1.In this study,a total of 211 PTN patients received percutaneous balloon compression therapy,of which 202 were effective and the effective rate was 95.7%.Among the effective treatment,186 patients were cured immediately after surgery.Sixteen patients did not get immediate relief after surgery,among which 10 patients had delayed relief of postoperative pain,the 10 patients relieved spontaneously within 2 weeks,and none of them occurred during follow-up visits.Six patients of the 16 patients felt pain on the affected side after surgery,and the pain disappeared completely the next day,it’s considered postoperative wound pain or delayed relief of pain.Of 198 patients with typical pear-shaped balloon shape,197 patients had no postoperative pain,and 1 patient still suffered pain after surgery.There were 9 patients with slightly pear-shaped balloon shape,4 of them still suffered pain after surgery,and 4 patients with non-pear-shaped balloon shape had no relief of pain after surgery.The puncture process of 7 patients was very difficult,and repeated adjustment could not achieve satisfactory shape,among which 3 patients had received radiofrequency ablation therapy.During the follow-up,5 patients had pain recurrence,all of them occurred within one year,and the one-year recurrence rate was 2.4%.Statistical analysis showed that the postoperative efficacy of PBC was not significantly affected by age,gender,pain side,pain distribution area and duration of disease(P>0.05).The shape of the balloon had a great influence on the postoperative efficacy of PTN patients(X2=132.2,P<0.001),the efficacy of typical pear-shaped patients was significantly higher than that of similar and non-pear-shaped patients.Due to the difficulty in obtaining satisfactory balloon shape,difficult puncture had an impact on postoperative efficacy(X2=37.09,P<0.001).2.The most common complication after PBC is numbness on the affected side.Of the 211 patients,202(95.7%)developed numbness on the affected side,including 2 patients with hypoesthesia and paresthesia,and paresthesia disappeared within 1 week.The facial numbness of patients gradually reduced with the extension of postoperative time.6 months after surgery,the numbness of patients gradually improved or well tolerated,and the numbness of patients with severe numbness is significantly reduced.The trigeminal inhibitory reflex occurred in 132 patients(62.5%)during puncture and balloon compression.115 patients(54.5%)had masticatory muscle weakness on the affected side after PBC operation.Follow-up observation showed that the symptoms gradually recovered 2 to 3 months after the operation,and the masticatory muscle strength of the patients basically returned to normal half a year later.There were 69 patients(32.7%)with herpes from the corner of the mouth,most of which occurred 1 to 3 days after the operation.However,the symptoms were improved after 1 to 2 weeks of follow-up observation.Temporary diplopia was observed in 4 cases after PBC operation,and symptoms disappeared without any special treatment within 3 weeks of follow-up observation.Postoperative symptoms such as swelling,pain and headache on the side,the patient returned to normal within 1 to 3 weeks after symptomatic treatment.In this group of patients,serious complications,such as weakened corneal reflex,disappearance,intracranial hemorrhage,infection,cerebrospinal fluid leakage,internal carotid artery fistula,etc.Were not observed,and no serious complications,such as death or disability were observed.With respect to postoperative symptoms such as lateral swelling and headache,the patient returned to normal within 1 to 3 weeks after symptomatic treatment was given.No serious complications,such as weakened corneal reflex,intracranial hemorrhage,infection,cerebrospinal fluid leakage,internal carotid artery fistula.No death,disability and other complications occurred.Conclusions:Percutaneous balloon compression for the treatment of primary trigeminal neuralgia is a minimally invasive,effective and safe surgical method,which has fewer complications and is suitable for clinical application.The shape of the balloon has a great influence on the efficacy of balloon compression.When the balloon is typical pear-shaped during operation,the postoperative efficacy is better,which is significantly better than that of the patients with only a little pear-shaped.When the balloon is not pear-shaped at all,the effect is worse.Difficult puncture may lead to unsatisfactory balloon shape.