Balloon Compression Rhizotomy

[Jan]

Medications are the first treatment usually prescribed for Trigeminal Neuralgia.  In many patients the disease can be treated for years using the various drugs available.  However, for those patients who are unable to control the pain with drugs alone or for whom the side effects of the drugs becomes intolerable there are surgical options available.

One of these options is the “Percutaneous Balloon Compression Rhizotomy.”   This is a procedure during which the Trigeminal nerve root is damaged by compression with a balloon at the end of a needle.  The term “Rhizotomy” actually means to damage a nerve root.  The “Percutaneous” means through the skin.   

With the patient under a general anesthetic, a needle is passed through the cheek into the skull so that its tip lies along the Trigeminal Nerve.  A small catheter with a balloon at the end is passed through the needle and the balloon inflated for a minute or two to cause an injury to the nerve.   The neurosurgeon uses X-rays and/or a fluoroscope to ensure the needle and catheter are in the correct place.

This procedure is a good option for those patients who are hesitant to undergo a craniotomy and MVD procedure either because they are reluctant to have major surgery or they have another health problem making surgery too dangerous.

About 90-95% of patients will find that the TN pain disappears immediately after the balloon procedure although for some patients it may take a day or so for the pain to go away completely.  The pain free period varies from person to person, but half the people will still be pain free after 5-8 years.   This procedure can be repeated if necessary.

Most patients will experience some degree of facial numbness post operatively.  This will decrease over time.  The numbness indicates the nerve has been damaged which is the aim of the surgery. 

There may be some weakness in the chewing muscles after the surgery.  This is usually temporary and will resolve over the first few weeks.
 
A small percentage of patients (up to 5%) may experience some complication.  These complications include meningitis, some difficulty chewing, a cheek hematoma, double vision, loss of the corneal reflex, anesthesia dolorosa, a sudden rise or drop in blood pressure, cerebrospinal fluid leaks and meningitis and an outbreak of cold sores.

Patient Information

Pre-op

•   The anesthetist and neurosurgeon will likely order some blood tests, a chest X-ray, ECG and in some instances an MRI.
•   You may be advised to stop taking any aspirin for 2 weeks prior to the surgery to help prevent bleeding.

Post-op

•   You will be given a schedule for the withdrawal of any drugs you are taking for TN.  Follow this schedule closely as drugs such as Tegretal should not be stopped abruptly.
•   Ice packs against the cheek will decrease bruising and swelling
•   Report any of the following symptoms to your doctor immediately:
o   Headache not relieved with Tylenol
o   Fever
o   Stiff neck
o   Drainage of clear fluid from the nose or down the back of your throat
o   Chest pain or shortness of breath

You should be able to resume your normal activities within a week