Technical considerations and outcome assessment in retrogasserian balloon compression for treatment of trigeminal neuralgia. Series of 901 patients

BACKGROUND: The aim of our study was to describe the retrogasserian balloon compression (RGBC) procedure with some personal tricks and to assess the long-term results. METHODS: Between 1985 and 2012, 901 patients, suffering from refractory trigeminal neuralgia (TN), underwent RGBC procedure in our department. Concerning the surgical technique, the introducer was in close contact with the posterior extremity of the horizontal plate of the palatine bone and had the direction of the bisector of the angle clivus-superior edge of the petrous bone on an X-rays sagittal view. No metallic material was inserted intracranially. The balloon was inflated with 0.7 cc of contrast medium for 6 min. RESULTS: At 1 month follow up, appreciable pain relief was obtained in 835 patients (92.7%). At 1 year, results were excellent in 605 patients (67.1%), satisfactory in 109 patients (12.1%), poor in 57 patients (6.3%), fair in 66 patients (7.3%), whereas recurrences were observed in the remaining 64 patients (7.2%). At mean follow up of 16,5 years, 559 (62%) patients remained pain free. Twenty six patients (2,8%) continued to experience severe pain. Recurrences occurred in two hundred and fifty patients (27,8%). Fifty two of them were operated on a third time and 22 underwent four procedures. CONCLUSION: RGBC is an appropriate and effective procedure for treatment of refractory TN, ensuring a long lasting pain relief predicted on three factors: pear shape of the balloon, its volume, and duration as mentioned earlier.