Repeated percutaneous balloon compression for recurrent trigeminal neuralgia: a long-term study

Background: Percutaneous balloon compression (PBC) is an alternative surgical treatment for trigeminal neuralgia refractory to carbamazepine. PBC is the preferred procedure for some patients. However, to our knowledge, the clinical results of repeat PBC have not been reported thus far.

Objective: The aim of this study was to evaluate the outcomes of and the complication rates associated with repeat PBC performed for recurrent trigeminal neuralgia, over an 8-year study period.

Methods: Until July 2004, we performed PBC in 272 consecutive patients with typical symptoms of unilateral trigeminal neuralgia at our hospital. PBC was successful in 43 patients, and they did not experience any pain for at least 3 months; however, symptoms recurred later. Among these 43 patients, 32 underwent a repeat (second) PBC whereas 11 received pharmacologic treatment. The repeat PBC was performed between March 2001 and December 2004, and the patients were followed up till June 2010.

Results: Thirty-two patients with recurrent trigeminal neuralgia participated in this study. The follow-up period ranged from 5.08 to 8.75 years (mean, 6.43 years). After the repeat PBC, 30 patients (93.8%) experienced immediate relief from neuralgia. None of the patients developed transient diplopia or anesthesia dolorosa. Although 2 patients (6.2%) experienced severe hypoesthesia, they could tolerate it. Six patients (18.8%) showed limited mandibular activity. No major surgical or anesthetic complication was observed, and death did not occur. Pain did not recur in any patient for 3 months after the surgery. The symptoms recurred in 5 patients (16.7%) within 2 years, in 7 patients (23.3%) within 3 years, and in 12 patients (40%) within 5 years after the surgery. Over the 8-year study period, symptoms recurred in 13 patients (43.3%).

Conclusions: Repeated PBC is recommended for patients with recurrent trigeminal neuralgia after the first PBC or other unsuccessful treatments. Although the recurrence rate associated with the repeat PBC was slightly higher than that associated with the first, repeated PBC was safe, less complicated, and associated with a low incidence of dysesthesia and had a high success rate.