Do bubbles matter amid PBC for trigeminal neuralgia?

Area of Science:

• Neurosurgery
• Pain Management
• Medical Imaging

Background:

• Percutaneous balloon compression (PBC) is a common neurosurgical treatment for trigeminal neuralgia.
• Successful PBC relies on achieving adequate pressure on the Gasserian ganglion, visualized as a full pear-shaped opacity.
• Air bubbles can cause a "bitten pear" appearance, which is often disregarded.

Purpose of the Study:

• To investigate the impact of bubbles, indicated by a "bitten pear" appearance, on the outcomes of percutaneous balloon compression for trigeminal neuralgia.

Main Methods:

• A retrospective analysis of 59 patients undergoing PBC between 2019 and 2021.
• Patients were categorized into "full pear" (no bubbles) and "bitten pear" (bubbles) groups.
• Efficacy was assessed using the Barrow Neurological Institute (BNI) scoring system, evaluating pain and numbness.

Main Results:

• The "bitten pear" group showed significantly higher recurrence rates compared to the "full pear" group by the last follow-up (52.9% vs. 88.1%, p < 0.01).
• Early effective rates were comparable (82.4% vs. 95.2%), but diverged over time.
• No significant difference in numbness incidence was observed between the groups.

Conclusions:

• The presence of bubbles, leading to a "bitten pear" appearance, negatively impacts the long-term efficacy of PBC for trigeminal neuralgia.
• Gas (bubbles) exerts less pressure than liquid, potentially reducing the effectiveness of Gasserian ganglion compression.
• Thorough air evacuation before injection is crucial for optimal PBC outcomes.