Percutaneous Balloon Compression
Balloon compression is an outpatient procedure for the treatment of trigeminal neuralgia. It is indicated for patients whose electric shock like pain no longer responds to medical therapy or for whom medical therapy causes unacceptable side effects. Balloon compression is not indicated for patients whose pain is burning or aching in quality.
The operation is performed under general anesthesia. A cannula is inserted through the cheek with radiologic imaging for guidance and directed to the forman ovale at the base of the skull. This is the hole through which the mandibular nerve exits from the skull, providing sensation to the jaw and motor function to the muscle that contracts the jaw. A balloon-tipped catheter is then threaded to the site about one inch beyond the skull base entrance where the trigeminal nerve passes through another hole, this one in the covering of the brain, called the dura, to enter Meckel's cave where the Gasserian ganglion is located.
The balloon is inflated for one minute to a pressure about one and one half times atmospheric pressure. The tip of the balloon compresses the nerve against the firm edge of the dura and the bone of the skull base. The pressure injures only the myelin, the insulation that covers the large nerve fibers that mediate the sensation of light touch in the face. By reducing this sensation in the face, this stops the trigger that sets off the short circuit that represents the electric shock trigeminal pain. After one minute the balloon is deflated and removed.
Surgery causes mild to moderate numbness and relieves pain in more than nine of ten cases. With time about 25% of patients will have recurrence of their pain, however six years after surgery 2/3 of patients remain pain free.
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