The Key to Percutaneous Balloon Compression Success: Pear or Banana?

The percutaneous balloon compression (PBC) procedure treats trigeminal neuralgia by compressing the Gasserian ganglion in Meckel's cave. On lateral fluoroscopy, a pear-shaped contrast-filled structure mainly consists of regenerative trigeminal rootlets, with a smaller, crescent-shaped, nonrenewable ganglion ('banana') at its base. To effectively minimize the risk of recurrence, it is crucial to apply precise and targeted pressure directly to the ganglion. To demonstrate that the bottom-boosted PBC process may effectively contribute to reducing recurrence.

From January 2019 to October 2023, a total of 371 consecutive cases of PBC were performed by the senior author (J.Z.) at XinHua Hospital. The cases were divided into two groups based on the operative strategy, excluding those with missing follow-up or unsuccessful pear shape achievement intraoperatively. Group Pear comprised those who achieved a typical pear shape using the traditional technique; Group Banana, included those who underwent adjustments of the balloon position after visualizing a pear shape, followed by retraction until a headless pear emerged.

A total of 328 participants were ultimately enrolled in this study, comprising 92 individuals in group Pear and 236 in group Banana. The efficacy upon awakening from anesthesia was 95.7% in group Pear versus 99.2% in group Banana (P > 0.05), declining to 75.0% and 92.4%, respectively, one year later (P < 0.01). Immediate ipsilateral numbness rates were 60.9% in group Pear and 43.2% in group Banana (P < 0.01), decreasing to 10.9% and 9.7%, respectively, after one year (P > 0.05).

A pear-shaped configuration indicates successful balloon entry into Meckel's cavity. To prevent recurrence and reduce complications, compression should focus on the base rather than the apex of the pear.