Percutaneous balloon compression versus radiofrequency thermocoagulation in patients with trigeminal neuralgia

Background: Percutaneous balloon compression (PBC) and radiofrequency thermoco-agulation (RFT) are widely used minimally invasive treatments for trigeminal neuralgia (TN). However, controversies persist regarding their comparative long-term efficacy, recurrence rates, postoperative physiological stress and inflammatory responses. This study is to analyze the efficacy of PBC and RFT in the treatment of patients with TN. Methods: This retrospective, single center, cohort study included 165 patients with primary TN, treated from January 2017 to December 2022, after failure or intolerance to medical therapy. The PBC group (n = 85), underwent percutaneous microballoon compression of the Gasserian ganglion, and the RFT group (n = 80) underwent radiofrequency thermocoagulation. The primary outcomes were pain relief, assessed using the Barrow Neurological Institute (BNI) pain intensity score, and pain recurrence rates at one and three years postoperatively. Secondary outcomes comprised pain relief rate at 24 hours post-surgery, serum inflammatory markers (Tumor Necrosis Factor-alpha (TNF-α), Interleukin-1β (IL-1β), and Interleukin-6 (IL-6)) at 7 days post-surgery, and levels of stress hormones (norepinephrine (NE) and cortisol (Cor)) at 1-and 2-days post-surgery. Results: At 24 hours postoperatively, no significant difference was observed in the pain relief effect between the two groups (p > 0.05). However, at 7 days post-operation, TNF-α, IL-1β, and IL-6 levels were significantly lower in the PBC group compared to the RFT group (p < 0.05). Similarly, at 1- and 2-day post-operation, norepinephrine and cortisol levels were significantly lower in the PBC group (p < 0.05). At 1, 3 years post-operation, the PBC group demonstrated significantly better pain relief and lower recurrence rates than the RFT group (p < 0.05). Conclusions: For the treatment of trigeminal neuralgia, PBC of the trigeminal ganglion provides effective pain relief with reduced postoperative inflammatory and stress responses. Compared with radiofrequency thermocoagulation, PBC might offer superior long-term efficacy and lower recurrence rates.

Trigeminal neuralgia; Rhizotomy; Electrocoagulation

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