Percutaneous balloon compression trigeminal rhizotomy complications

by

Percutaneous balloon compression trigeminal rhizotomy complications

Percutaneous balloon compression trigeminal rhizotomy-related trigemino-cardiac reflex (TCR) can induce dramatic hemodynamic disturbances 1).

Postoperative morbidity included common side effects such as facial numbness in 66 (97.1 %) patients, masseter muscle weakness in 19 (27.9 %) patients, paresthesia in 7 (10.3 %) patients, and diplopia secondary to abducens nerve weakness in 1 (1.5 %) patient 2)

The main reason for ineffective or short-term recurrence of PBC in trigeminal neuralgia patients is the ineffectively compressed of trigeminal ganglion.According to the different types of patients,the use of individualized modified surgical scheme can improve the efficacy of PBC surgery 3).

Extracranial complications

Bloody saliva Stensen duct puncture

Facial hematoma/A-V fistula Puncture of internal MA and pterygoid plexus

Injury to ICA, jugular vein Excessively medial displacement of the needle causing injury to the ICA in the FL,

posterolateral displacement causing injury to the jugular vein

Injury to Eustachian tube Posterior displacement of the needle

Blindness Needle inserted anteriorly and medially passing through inferior orbital fissure to the orbital apex

Intracranial complications

Carotid-cavernous fistula ICA injury in the CS

Temporal lobe hematoma Dura mater penetration and intradural balloon inflation

Brainstem lesion Guiding stylet/balloon catheter far from the petrous ridge

Diplopia Compression of CN VI (most common) or CN IV

Meningitis Oral mucosa puncture, contamination or improper sterility 4).

Lichtor and Mullan from one hundred patients treated by this method that have been followed for 1 to 10 years; treatment has been technically successful in 97% of cases. Relief persisted at five years in 80%, and it is estimated that at 10 years the figure will be 70%. There were no deaths, no cerebral damage, no keratitis, and no analgesia dolorosa; 4% of the patients reported dysesthesia 5).

Most of the minor surgical complications observed were also related to avoidable technical errors 6)

1)

Wang CM, Guan ZY, Wang QC, Zhang J, Ma Y, Zhao P. The Effect of Depth of Anesthesia on Hemodynamic Changes Induced by Therapeutic Compression of the Trigeminal Ganglion. J Neurosurg Anesthesiol. 2019 May 27. doi: 10.1097/ANA.0000000000000612. [Epub ahead of print] PubMed PMID: 31145173.
2)

Du, YF., Gu, Q., Yang, DB. et al. Percutaneous balloon compression for primary trigeminal neuralgia in patients older than 80 years. Chin Neurosurg Jl 1, 8 (2015). https://doi.org/10.1186/s41016-015-0007-2
3)

Chong YL, Xu W, Wang J, Jiang CR, Liang WB. [The ineffective or short-term recurrence of trigeminal neuralgia after microballoon compression:different causes and management strategies]. Zhonghua Wai Ke Za Zhi. 2022 May 1;60(5):473-478. Chinese. doi: 10.3760/cma.j.cn112139-20210825-00391. Epub ahead of print. PMID: 35359090.
4)

https://www.reumatek.com/wp-content/uploads/Percutaneous_Balloon_Compression_for_Trigeminal.pdf
5)

Lichtor T, Mullan JF. A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion. J Neurosurg. 1990 Jan;72(1):49-54. doi: 10.3171/jns.1990.72.1.0049. PMID: 2294184.
6)

Lobato RD, Rivas JJ, Sarabia R, Lamas E. Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia. J Neurosurg. 1990 Apr;72(4):546-53. doi: 10.3171/jns.1990.72.4.0546. PMID: 2319312.

Leave a Reply