Introduction: Percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) are two minimally invasive techniques for treating trigeminal neuralgia (TN). They were both described over thirty years ago, and are now routine procedures around the world, but no study has yet compared these methods on equal terms.
Methods: Data from 129 PRGRs and 72 PBCs performed in Umeå between 1986–1999 and 2000–2010 respectively, on patients without previous history of surgery for their TN were analyzed. Indication for surgery did not differ between the two techniques. At follow-up, a pain-free state was defined as pain free without medication for TN. Data from clinical examinations and electrical transcutaneous stimulation collected preoperatively and at two time points postoperatively were analyzed to objectify changes in sensory function. Side effects associated with each procedure were also reviewed.
Results: Duration of complete pain relief was not significantly different between the two techniques (median equaled 24 months for PBC and 21 months for PRGR). Eight of the patients undergoing PRGR had undergone previous attempts where no glycerol had been injected due to technical complications. Raised sensory and pain threshold levels were observed postoperatively at electrical stimulation and standard clinical
testing. Differences were less prominent at late follow up (3-9 months) but still significant (p<0.01) for everything but pain threshold after PBC. Corneal sensibility was significantly more often affected by PRGR. Complication rates were generally low, except for dysestesia after PRGR, which occurred in 25% of the cases compared to 4% after PBC.
Conclusions: PBC and PRGR are both effective treatments for TN, and generally safe. PBC do however result in less cases of postoperative dysestesia and decreased corneal sensitivity, and we found no cases of technical failures associated with PBC in this series.
Patient Care: By highlighting the differences in possible side effects and complications between two treatments of roughly equal potential for pain release, the research will provide surgeons with an increased possibility to inform patients and to choose an appropriate technique for each individual case.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of PBC and PRGR in the management of TN, and of the contribution of this current research to the literature, 2) Discuss, in small groups, the advantages and disadvantages of PBC and PRGR respectively, for treatment of patients with TN, and 3) Identify an effective treatment for TN, while also have awareness of possible side-effects.