Comparison of percutaneous balloon compression and radiofrequency-thermocoagulation in the management of trigeminal neuralgia

Abstract

Abstract Purpose: To compare percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFTC) for the treatment of trigeminal neuralgia (TGN). Methods: Retrospective single center analysis of data from 230 patients with TGN that underwent 202 PBC (46%) and 234 RFTC (54%) from 2002 to 2019. Comparison of demographic data and TGN characteristics between procedures as well as assessment of 1) initial pain relief (IPR) by an improved Barrow Neurological Institute (BNI) pain intensity scale of I-III; 2) recurrence free survival (RFS) of patients with a follow-up of at least six months by Kaplan-Meier analysis; 3) risk factors for failed IPR and RFS by regression analysis and 4) complications and adverse events. Results: IPR was achieved in 353 (84.2%) procedures and showed no significant difference between PBC (83.7%) and RFTC (84.9%). Patients who suffered from multiple sclerosis (Odds ratio 5.34) or had a higher preoperative BNI (Odds ratio 2.01) showed a higher risk of not becoming pain free. RFS in 283 procedures was longer for PBC (44%) with 481 days compared to RFTC (56%) with 421 days (p=0.036) but without statistical significance. The only factor that showed a significant influence on RFS rates was a postoperative BNI ≤ II (P=<0.0001). The complication rate of 22.2% as well as zero mortality showed no difference between the two procedures (p=0.162). Conclusion: Both percutaneous interventions lead to a comparable IPR and RFS with a low and comparable probability of complications. An individualized approach, considering the advantages and disadvantages of each intervention should guide the decision-making process.