Operative Neurosurgery 29:263–270, 2025
This prospective study found that higher intraluminal balloon pressure during percutaneous balloon compression for trigeminal neuralgia reduces long-term pain recurrence without increasing persistent facial numbness. Preoperative MRI-based Meckel’s cave assessment and intraoperative pressure monitoring help optimize outcomes and balance pain relief with sensory side effects.
• Percutaneous balloon compression (PBC) is used to treat trigeminal neuralgia (TN), with outcomes influenced by intraluminal balloon pressure, balloon volume, and Meckel’s cave volume.
• Preoperative high-resolution MRI enables 3D reconstruction of Meckel’s cave, aiding in predicting intraoperative balloon volume.
• Intraoperative monitoring of balloon pressure and volume was performed in 37 patients; primary outcomes were facial numbness and pain recurrence up to 24 months.
• Facial numbness was common in the first month (38%), but typically resolved by 24 months; numbness was not linked to balloon pressure.
• TN recurrence rate was about 25% at 24 months and was significantly associated with lower intraluminal balloon pressure.
• No significant differences in Meckel’s cave or balloon volume were observed between subgroups, but Meckel’s cave volume correlated positively with balloon volume.
• Authors recommend maintaining intraluminal balloon pressure around 135.7 ± 27.1 kPa (with 120 seconds compression) to minimize recurrence without increasing sensory deficits.
• Perioperative assessment of balloon compression (including MRI and pressure monitoring) is feasible and may help balance TN recurrence risk and sensory complications.
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