Balloon Compression Rhizolysis in the Surgical Management of Trigeminal Neuralgia

Abstract

Abstract To overcome some of the disadvantages of the current percutaneous surgical approaches to trigeminal neuralgia, we offer balloon compression rhizolysis (BCR) as an alternative. Guided by fluoroscopy, a 4 French Fogarty catheter is introduced into Meckl's cave, and its balloon is inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion and rootlets, under light endotracheal anesthesia. All patients experience immediate pain relief, with mild numbness in all three divisions, but with corneal sparing. Often, weakness of ipsilateral mastication appears transiently. In 33 procedures performed in 25 patients aged 48 to 86, with a follow-up period of 6 months to 7 years, there were 25 long-lasting cures (76%) and 8 recurrences. These results are fully comparable to those of other “destructive” procedures. There was no anesthetic complication and no mortality. The advantages of this procedure, besides its efficacy and low rate of dysesthesia, include absence of discomfort for the patient, short operative time, technical ease for the neurosurgeon, minimal morbidity, and no risk to corneal sensation. We think that microvascular decompression (MVD) should be the first operation considered for trigeminal neuralgia, but we advocate BCR as the procedure of choice in the aged and medically infirm, especially when V1 pain is present, in patients with multiple sclerosis, for recurrences after other procedures, and in virtually any situation in which MVD is, for some reason, not feasible.