Background Trigeminal neuralgia (TN) causes severe paroxysmal facial pain and quality-of-life impairment. Percutaneous balloon compression (PBC) is minimally invasive, yet efficacy and complication rates remain variable. We conducted a single-centre prospective cohort study to define phase-specific intraballoon pressure thresholds that maximize pain relief while minimising facial hypoaesthesia and recurrence. Methods 115-TN patients undergoing PBC (Jan 2017–Aug 2024) had real-time pressure recorded at 1 Hz. Pressure morphometrics were classified into pear-shaping, maintenance and full-compression phases. Reference intervals (RI) were established with the non-parametric CLSI C28-A2 method ( n ≥ 4,000 measurements per phase). Associations between phase pressures and 24-h hypoaesthesia grade or 24-month recurrence were examined with Spearman correlation and Cox regression (Schoenfeld validation). Results Higher phase pressures correlated with more severe hypoaesthesia ( ρ = 0.44–0.62, P 0.01), whereas lower pressures predicted increased recurrence (HR = 0.87 per 5 kPa, 95% CI 0.80–0.94, P = 0.002). Optimal RI were: pear-shaping 126.5–156.8 kPa, maintenance 117.9–136.1 kPa, full-compression 119.9–141.9 kPa. Operating within these bands produced BNI-I/II pain relief in 98% of patients with only 16% transient Grade-III hypoaesthesia. Conclusion Real-time, phase-adapted pressure control within the proposed RI allows surgeons to standardize PBC while individualizing the therapeutic window, improving safety and durability of pain relief.
Wang et al. (Tue,) studied this question.