Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia

Abstract

Background: Despite >30 years of clinical use, the literature is still sparse when it comes to comparisons between percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizolysis (PRGR) as treatments for trigeminal neuralgia.

Objective: To perform a retrospective cohort comparison between PBC and PRGR with regard to therapeutic effect, side effects, and complications.

Methods: Medical records and follow-up data from 124 primary PRGRs performed from 1986 to 2000 and 82 primary PBCs performed from 2000 to 2013 were reviewed. All patients had undergone clinical sensory testing and assessment of sensory thresholds. Analyses were performed to compare duration of pain relief, frequency of sensory disturbances, and side effects.

Results: Median duration of pain relief was 21 months after PRGR and 20 months after PBC. Both methods carried a high risk of hypesthesia/hypalgesia (P < .001) that was partly reversed with time. Decreased corneal sensibility was common after PRGR (P < .001) but not after PBC. Dysesthesia was more common after PRGR (23%) compared after PBC (4%; P < .001). Other side effects were noted but uncommon.

Conclusion: PBC and PRGR are both effective as primary surgical treatment of trigeminal neuralgia. Both carry a risk of postoperative hypesthesia, but in this series, the side effect profile favored PBC. Furthermore, PBC is technically less challenging, whereas PRGR requires fewer resources. Between these 2 techniques, we propose PBC as the primary surgical technique for percutaneous treatment of trigeminal neuralgia on the basis of its lower incidence of dysesthesia, corneal hypesthesia, and technical failures.

FIGURE 1

Diagram outlining the patient selection from all patients receiving a percutaneous surgical treatment for trigeminal neuralgia (TN) without a history of previous surgery on the affected side until May 2013 at the Umeå University Hospital. PBC, percutaneous balloon compression; PRGR, percutaneous retrogasserian glycerol rhizotomy.

FIGURE 2

Kaplan-Meier plot illustrating the therapeutic effects after percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) in months of pain relief without medication. The patients had not previously undergone a completed ipsilateral surgical procedure for trigeminal neuralgia. A log-rank test showed no significant difference between the curves.

FIGURE 3

Thresholds in amperage for perception and pain as measured by sensimetric testing in patients treated with percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) for trigeminal neuralgia. Means for preoperative thresholds are presented from the paired t test with early postoperative thresholds. Means for preoperative thresholds from the paired t test with late postoperative thresholds, thus including fewer cases, are not presented, but they approximate the presented values very well. P values for postoperative thresholds relate to a comparison with preoperative thresholds. P values for late postoperative thresholds are presented for comparisons with both preoperative and postoperative thresholds.

FIGURE 4

Distribution within groups of patients undergoing percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) of sensation at the pain site according to a 4-grade scale ranging from normal to totally impaired. Distribution difference between 3 time points for each modality and treatment are examined with Wilcoxon signed-ranks tests. P values in the postoperative bars relates to a comparison with the related preoperative distribution. P values to the left in the late postoperative bar relate to a comparison with the related preoperative distribution, whereas P values to the right in the late postoperative bar relate to a comparison with the related postoperative distribution.