Outcomes After Repeat-Percutaneous Balloon Compression for Recurrent Trigeminal Facial Pain

Surgical techniques for treating neuralgic facial pain, including percutaneous balloon compression (PBC), glycerol rhizotomy, stereotactic radiosurgery, and radiofrequency thermocoagulation, provide significant, albeit temporary, pain relief, often necessitating repeat procedures. Although repeated radiofrequency thermocoagulation can cause masseter weakness, reduced corneal reflex, and deafferentation pain, repeated PBC data are lacking. The aim of this study was to investigate the safety and efficacy of repeated PBC.

Data were collected retrospectively from medical records and prospectively from a Qualtrics questionnaire of PBC patients at our institution. The primary outcome was pain-free duration after each procedure. Secondary outcomes included facial numbness, pain severity, and complications. Subanalyses assessed the impact of compression time and multiple sclerosis. Descriptive statistics summarized participant demographics and examined associations with outcomes. The study was approved by the Institutional Review Board. All participants provided verbal informed consent.

Thirty six patients received ≥1 PBC from 2019 to 2023. Minor transient complications occurred in 10.9% of the procedures. One patient had a carotid artery puncture. In 2 cases, patients did not achieve postoperative facial numbness, leading to a repeat procedure within 5 months. The average balloon inflation time was 5 minutes for initial procedures and 6 minutes across all procedures. Increased balloon compression time was not associated with increased complications. During midterm follow-up (mean: 33 months; range: 1-81 months), 72% maintained complete relief from the balloon compression procedure(s), 71% were able to permanently decrease or eliminate their facial pain medications, and 11% required ≥3 procedures.

Repeat balloon compression procedures effectively managed recurrent pain, reducing recurrence rates without increasing complications, regardless of inflation times or number of procedures performed. No patients in this cohort experienced deafferentation pain. Further research is needed to compare trigeminal nerve-related complication profiles between repeat PBC and other repeated percutaneous or transcutaneous procedures to identify potential differences between modalities.