Effective management of lower divisional pain in trigeminal neuralgia using balloon traction

摘要

Percutaneous balloon compression (PBC) of the trigeminal ganglion uses a differential injury of axons to interfere with the nerve's ability to transmit signals. In our experience, patients with lower divisional pain (V3) are often more difficult to control using PBC. We describe a modification to the PBC technique for patients with lower division (V3) pain, and present our experience to date. Percutaneous balloon compression (PBC) of the trigeminal ganglion with a balloon catheter was introduced by Mullan and Lichtor in 1983.l The majority of studies reporting outcome following PBC do not distinguish between successes based on which division of the trigeminal nerve is affected. Some adapt their technique in an attempt to target the balloon at various portions of the nerve,2 while others rely on balloon shape as a guide for filling Meckel's cave to compress all divisions,3 or adjust the duration of compression in order to be successful. Our study distinguishes patients on the affected trigeminal division and a technique used to improve the results in patients with V3 pain. In our experience, patients with lower divisional pain (V3) are often more difficult to control using PBC - an observation also reported previously by Frank and Fabrizi 19894 due to its anatomical position. They therefore proposed that V3 pain was best managed with thermocoagulation. We describe a modification of the PBC technique for patients with lower division (V3) pain, targeting the V3 fibres with traction method as they pass through foramen ovale, and present our experience to date.