One Hundred Eleven Percutaneous Balloon Compressions for Trigeminal Neuralgia in a Cohort of 66 Patients with Multiple Sclerosis

Abstract

Abstract BACKGROUND Trigeminal neuralgia associated with multiple sclerosis (MS–TN) is comparatively rare and larger series of percutaneous balloon compression (PBC) in such cases are few in the literature. OBJECTIVE To evaluate the results after PBC for MS–TN with regards to therapeutic effect, side effects, and complications. METHODS One hundred eleven procedures with PBC performed in 66 cases of MS–TN were analyzed. Therapeutic effect was measured as postoperative time to pain recurrence without medication. All complications were compiled and the sensory function was evaluated in a subgroup of cases. RESULTS The initial pain free rate was 67% and the median time to pain recurrence was 8 mo. Thirty-six patients were treated with PBC only, and among them, the results were worse if treated 3 to 4 times before, compared to first treatment (P = .009-.034). Patients who had several PBCs had worse results already after the first surgery (P < .001). A significant number of patients had impaired sensation to light touch directly after surgery, which was normalized at the late follow-up. Sensimetric testing showed raised thresholds for perception and pain directly after surgery (P = .004-.03), but these were also normalized at the late follow-up. CONCLUSION PBC is a treatment that can be effective for many patients with MS–TN. Repeated previous surgeries is a risk factor for an unsatisfactory outcome. However, the patients with multiple surgeries had less satisfactory results already at the first procedure, indicating that a therapy resistant disease can be predicted after the first two PBCs. Postoperative sensory deficits were common but not lasting.