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One hundred eleven Percutaneous Balloon Compressions for Trigeminal Neuralgia in a Cohort of 66 Patients with Multiple Sclerosis
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.ORCID iD: 0000-0001-9508-3352
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2019 (English)In: Operative neurosurgery, ISSN 2332-4252Article in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Place, publisher, year, edition, pages
Oxford University Press, 2019.
Keywords [en]
Balloon compression, Multiple sclerosis, Trigeminal neuralgia
National Category
Other Clinical Medicine Neurology Surgery
Research subject
Neurosurgery
Identifiers
URN: urn:nbn:se:umu:diva-158351DOI: 10.1093/ons/opy402PubMedID: 30690631OAI: oai:DiVA.org:umu-158351DiVA, id: diva2:1306778
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-25
In thesis
1. Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia
Open this publication in new window or tab >>Percutaneous Balloon Compression for the Treatment of Trigeminal Neuralgia
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. Trigeminal neuralgia (TN) is a paroxysmal unilateral facial pain condition. That it is rather rare is of little comfort to those who are affected, as TN is often described as one of the worst pains known to mankind. Advanced age and multiple sclerosis (MS) are risk factors for developing TN. The first line of treatment is medical, primarily with carbamazepine. When medical treatment fails, as it does in many patients, there are several surgical options. One of the minimally invasive options, suitable for patients with comorbidity, is percutaneous balloon compression (PBC). Despite its introduction in the early 1980s, PBC is arguably the least well studied of the minimally invasive procedures for the treatment of TN.

Aims. The aim of this thesis was to evaluate the efficacy of PBC, both overall and in MS-TN patients specifically. Further, it intended to identify and evaluate pre- and intraoperative parameters associated with the efficacy of PBC. It also investigated changes in sensory function after PBC, and identified side effects and complications associated with PBC. Finally, it sought to evaluate how efficacy, side effects and complications differed between PBC and another minimally invasive technique; percutaneous retrogasserian glycerol rhizotomy (PRGR).

Methods. Cohorts of patients treated with PBC in Umeå and Stockholm, and with PRGR in Umeå, were followed retrospectively. Data from an existing database was combined with data from medical records, radiographs and telephone interviews.

Results. After PBC, 90 % of the patients were completely pain free without medication for TN. The median time to recurrence of pain was 28 months. In patients with concurrent MS, the initial success rate was 67 % and the median time to recurrence was 8 months. In patients without MS, who had not previously been treated surgically, the initial success rate was 91 % and the median time to recurrence was 48 months. The procedure could, however, be repeated with good results. A good compression, indicated by a pear-shaped balloon as seen on intraoperative lateral radiograph, was crucial to achieve good pain relief. Postoperative hypoesthesia was present in the majority of patients, but after 3-6 months, sensibility was partly or fully normalized in most patients. Severe complications were rare, but included transient cardiac arrest, meningitis and dysesthesia. The side effects profile was favorable to that of percutaneous retrogasserian glycerol rhizotomy, in that the latter produced more cases of dysesthesia and decreased corneal sensibility. The efficacy of the two treatments were, however, not significantly different.

Conclusions. PBC is an effective and relatively safe treatment option for patients with TN refractory to medical treatment. It deserves its place among the standard treatments for TN, and could be considered for those patients eligible for surgery for which open surgery is a less suitable option.

 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2019. p. 63
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2032
Keywords
trigeminal neuralgia, multiple sclerosis, surgery, percutaneous balloon compression, percutaneous retrogasserian glycerol rhizolysis
National Category
Other Clinical Medicine
Research subject
Neurosurgery
Identifiers
urn:nbn:se:umu:diva-158352 (URN)978-91-7855-065-4 (ISBN)
Public defence
2019-05-17, Hörsal B, Unod T9, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2019-04-26 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically approved

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Asplund, PärBergenheim, A. Tommy

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