Balloon Compression of the Trigeminal Nerve

Trigeminal neuralgia (TN), or tic douloureux, is a chronic pain syndrome characterized by recurrent attacks of lancinating facial pain occurring in the distribution of one or more divisions of the trigeminal Nerve. When trigeminal neuralgia becomes refractory to medical management, surgery becomes imminent. Glycerol rhizolysis, thermocoagulation, and Percutaneous balloon compression (PBC) are well established in the treatment of TN. It is indicated in patients who have failed medical therapy, TN in association with multiple sclerosis (MS), young patients willing to accept the associated mild numbness occurring after surgery. Should be avoided in patients with atypical facial pain or post-herpetic pain and contralateral masseter weakness. Light sedation with anxiolytics such as benzodiazepines and fast-acting opioids such as Fentanyl is used at some settings, although the majority of the patients require general anesthesia with intratracheal intubation. Long-term pain recurrence varies between 20 and 43%, and immediate pain relief is higher than 90%. Late regeneration of damaged nerves might be a factor leading to higher recurrence rates. Studies often reported longer pain relief with balloon compression than glycerol rhizolysis and thermocoagulation. PBC leads to numbness and a few minor and transitory complications. PBC following previous percutaneous procedures was found to be highly effective.