Influence Of Individual Factors On The Efficacy Of Percutaneous Balloon Compression In The Treatment Of Primary Trigeminal Neuralgia

Primary trigeminal neuralgia(PTN)is a common functional disease in neurosurgery.Its attack is often manifested as severe knife-like and electric shock pain in the face of patients,which seriously endangers the physical and mental health of patients.The Chinese Expert Consensus on the Treatment of Trigeminal Neuralgia by Percutaneous Balloon Compression(2022)recommends that patients with PTN undergo Percutaneous Balloon Compression(PBC)to effectively relieve facial pain,especially for elderly patients with poor general conditions or PTN patients who refuse to undergo craniotomy.Pain recurrence after PBC is a major problem that needs to be solved at present.Many studies have expounded that balloon factors such as balloon shape,pressure,position and compression time have an important impact on the prognosis of PBC.However,in the long-term clinical work,we found that even if PBC surgery was standardized and balloon factors were controlled,some patients still experienced pain recurrence.Therefore,we consider whether there will be any unknown factors that will affect the efficacy of PBC besides balloon factors.To clarify this problem,we divided the factors that affect the efficacy of PBC into intraoperative balloon factors,patient individual factors and other factors(operator experience,anesthesia level and nursing quality,etc.),and conducted a retrospective clinical study to explore the relationship between individual factors and the efficacy of PBC on the basis of controlling balloon factors and other factors.Objective:To explore the influence of individual factors on the efficacy of percutaneous balloon compression in the treatment of primary trigeminal neuralgia.Methods:The clinical data of 89 PTN patients treated with PBC from November2018 to February 2022 were analyzed retrospectively,The pain score of Barrow Neurological Institute was used to grade facial pain.Follow up and record the pain recurrence(BNI pain score)at 3,6,9 and 12 months after the operation,according to the follow-up results at the 12th month,the patients were divided into cure group(BNI score I-II)and recurrence group(BNI score III-V),The relationship between individual factors such as sex,age,body mass index,basic diseases(hypertension,diabetes),side,disease duration,involved branches,surgical history,preoperative BNI pain score,size of external orifice of foramen ovale(including length diameter,transverse diameter,length diameter ratio,transverse diameter ratio)and postoperative recurrence of PBC was analyzed between the two groups.Results:During the follow-up period,18 patients experienced pain recurrence.Univariate analysis showed that there was no significant difference in sex,age,hypertension,diabetes,side,involved branches,preoperative BNI pain score,transverse diameter and transverse diameter ratio of FO between the cure group and the relapse group(P>0.05);BMI,disease duration,operation history,length to diameter and length to diameter ratio of FO were related to the postoperative effect(P<0.05).Multivariate logistic regression analysis of significant individual factors showed that BMI≥24kg/m~2,disease duration≥5 years,and previous surgical history were independent risk factors for postoperative pain recurrence(P<0.05),and FO length was a protective factor for postoperative recurrence(P<0.05).ROC curve analysis showed that FO length had a predictive effect on pain recurrence after PBC(P<0.05),with a predictive effect of 68.9%.The calculated maximum Joden index is 0.359,the corresponding FO length diameter is 6.74mm,the sensitivity is 0.803,and the specificity is 0.556.Conclusion:PBC is an effective surgical treatment for PTN,and individual factors have an important impact on the recurrence of pain after PBC.