Introduction: Treatment in trigeminal neuralgia (TN) must be adapted in each patient. Surgeons must be conscious of medical, surgical, and radiation treatment modalities to suggest ideal management. Gamma Knife Radiosurgery (GKRS) could be used multiple times compared with Percutaneous retrogasserian balloon compression for pain control. The objective of this study is evaluate the efficacy of Gamma Knife Radiosurgery and retrograssian balloon compression in TN refractory for prior GKRS.
Methods: Retrospective chart review assessed between January 2010 and March 2013, 103 patients was added. Patients with a diagnosis of secondary trigeminal neuralgia and/or atypical facial pain as well as patients with a history of previous vascular decompression and/or TNA blocks were excluded. Demographic characteristics, operative details, and perioperative pain treatment data were collected. Primary end points included post operatory pain relief, levels of carbamazepine, facial numbness, and complications. Continuous and categorical data were analyzed with the Wilcoxon rank-sum test, Pearson’s chi-square test, or Fisher’s exact test, as appropriate.
Results: Radiosurgery and balloon compression groups contained 59 and 62 patients, respectively. Balloon compression had a lower mean post-operative pain control (36.7% vs. 19%; p=0.0281) and mean calculated pain control in VAS scale at 2 weeks (47.3% vs. 22.65%; p=0.0236), this did not translate to a statistically significant difference in mean pain control at 3 months (68.7% vs. 83.93% p=0.137), 18 months (57.8%. vs. 73.93% p=0.098) and carbamazepine usage after 3 months (Balloon Compression (31.9%) vs. Gamma knife (37.7%); p=0.71). Most common side effects Facial Numbness post op v2,v3 distribution (64.23%. vs. 13.12%; p=0.00192), and 3 months (24.68%. vs. 17.29%; p=0.034)
Conclusions: Balloon compression decreased acute primary trigeminal neuralgia, but not provided a clinical substantial advantage comparing with Gammaknife radiosurgery in terms of decreasing pharmacological dosage and pain relief in a 24 month period.
Patient Care: Current tools for intractable facial pain.
Learning Objectives: Current treatment of trigeminal neuralgia after first surgical procedure