Clinical Study of Modified Percutaneous Balloon Compression for the Treatment of Primary Trigeminal Neuralgia

Abstract Background: The traditional percutaneous balloon compression（TPBC） is usually performed under C-arm guidance for puncture, which carries the risk of repeated punctures, multiple X-ray exposures, a high incidence of postoperative complications, and poor prognosis. The improved percutaneous balloon compression(IPBC) using Meckel's cave as the target point with robot-assisted puncture can not only increase the success rate of the first puncture, reduce postoperative complications, but also improve clinical efficacy. However, there have been no reports on whether IPBC is superior to TPBC in clinical studies. Objective: This study aims to compare the safety and effectiveness of IPBC and TPBC in the treatment of primary trigeminal neuralgia (PTN). Methods: We retrospectively analyzed the clinical data of 66 PTN patients admitted to the Department of Neurosurgery at People's Hospital of Baise City and underwent PBC treatment from May 2020 to October 2022. The patients were divided into the IPBC group (n = 33) and the TPBC group (n = 33) according to the surgical method. General clinical data, recent clinical outcomes (operation time, puncture times, X-ray exposure times, balloon volume, number of "pear-shaped" balloons, postoperative complications), NRS scores, and BNI classification were recorded for both groups. A 6-month follow-up was conducted for overall assessment of postoperative clinical efficacy. Results: All 66 patients underwent successful surgeries. There were no statistically significant differences (P>0.05) between the two groups in general clinical data (gender, age, course of disease, affected side, preoperative NRS score), balloon volume, and postoperative complications (corneal inflammation, diplopia, herpes zoster). The operative time for IPBC was 10.73±2.55 min, with a first puncture success rate and a "pear-shaped" balloon count both reaching 100%. X-ray exposure was 4 times, and there were 3 cases of weakened chewing muscles (9.09%) and 1 case of postoperative corneal inflammation (3.03%), which were significantly better than those in the TPBC group, showing a significant difference between the two groups (P<0.05). Within 6 months of postoperative follow-up, there were no statistically significant differences (P>0.05) in BNI classification and NRS scores between the two groups, but the effective rate of IPBC was 96.97%, while that of TPBC was 93.94%. The BNI classification and NRS scores on the first day and 1 month postoperatively were significantly better in the IPBC group than in the TPBC group, showing a significant difference between the two groups (P<0.05). Conclusion: The modified percutaneous balloon compression technique, with the Meckel's cave as the target and performed under robotic assistance, demonstrates a high rate of initial puncture success, low incidence of complications, and superior short-term clinical efficacy in the treatment of primary trigeminal neuralgia. This approach provides important reference value for improving the clinical efficacy of PTN.