Association between intraoperative balloon morphology and postoperative sensory dysfunction after percutaneous...

Percutaneous balloon compression (PBC) is widely used for trigeminal neuralgia, but the association between intraoperative balloon morphology and postoperative sensory outcomes remains unclear. Defining this relationship may improve technique and risk stratification. Prior studies suggest selective injury to large myelinated fibers rather than generalized sensory fiber or ganglion injury, and balloon morphology should be interpreted as a procedural marker rather than a direct measure of neural injury.

We retrospectively identified patients who underwent PBC for trigeminal neuralgia from institutional records. Of 603 screened patients, 566 met eligibility criteria. Sensory outcomes were assessed using standardized examinations and a modified Barrow Neurological Institute (BNI) classification. The primary endpoint was moderate-to-severe sensory dysfunction at 3 months. Propensity scores based on demographic, clinical, and biochemical variables generated 102 matched pairs. Univariable and multivariable logistic regression evaluated the association between balloon morphology and postoperative sensory dysfunction, with prespecified subgroup analyses by disease duration and procedural factors. Balloon morphology was analyzed as a fluoroscopic procedural marker; intraluminal pressure was not measured.

Among 566 eligible patients, 118 (20.8%) developed moderate-to-severe postoperative sensory dysfunction, while 448 had none or mild impairment. After matching, 204 patients were analyzed, and baseline covariates were well balanced (standardized mean differences <0.1). Non-pear-shaped balloon configuration was more frequent in patients with moderate-to-severe sensory dysfunction. In multivariable analysis, non-pear-shaped morphology remained associated with higher odds of moderate-to-severe impairment at 3 months (adjusted OR, 1.82; 95% CI, 1.09-3.05; p = 0.021), though this reflects an observational association rather than causal injury. Longer disease duration and smaller balloon volume were also significant predictors, whereas compression time showed a weaker, statistically uncertain association. Subgroup analyses showed consistent risk elevations for non-pear-shaped morphology without significant effect modification.

Intraoperative balloon morphology is observationally associated with sensory outcomes after PBC. Non-pear-shaped patterns may indicate higher risk of moderate-to-severe sensory dysfunction and serve as a procedural quality marker, but this should not be interpreted as direct ganglion injury or generalized sensory fiber damage.