Percutaneous Microballoon Compression Of The Gasserian Ganglion Treatment Of Secondary Trigeminal Neuralgia

Objective Secondary trigeminal neuralgia is also called symptomatic trigeminalneuralgia (STN). Is due to trigeminal neuralgia caused by different kinds of organicdisease from intracranial or extracranial. It can be secondary to cerebellopontine angle,trigeminal gasserian ganglion or root of the tumor, vascular malformation, aneurysm,arachnoiditis and diseases such as multiple sclerosis. In cerebellopontine angle (CPA)tumor is the most common cause of trigeminal neuralgia. Tumor resection is currentlythe only can be considered to be against secondary trigeminal neuralgia "cause"treatment of surgical treatment, but some don’t want to or poor adherence to craniotomysurgery patients cannot undergo surgery, or due to the weak and elderly, merge serioussystem disease of elderly patients can’t tolerate surgery, or already in terminal cancerpatients, when we consider necessary to this part with the aid of surgical method to treatpatients, the goal of treatment should be safe, effective and fewer complications andmild, even just to relieve symptoms sometimes. Mullan, etc in the early1980’s firstreported percutaneous microballoon compression of the gasserian ganglion (PMC forshort) treatment of trigeminal neuralgia, because the technology is safe and effective,easy to operate, then could be carried out widely in many countries, our country startedlate in this aspect, clinical reports is very few, reported for the first secondary trigeminalneuralgia treatment is less, this paper aims to introduce the PMC method treatment of aset of preliminary experience of57patients with secondary trigeminal neuralgia.Materials and methods From January2005to June2012, altogether with PMCminimally invasive surgical treatment of57cases of secondary trigeminal neuralgiapatients, all patients with preoperative CT or MRI confirmed for secondary trigeminalneuralgia. Which caused by epidermoid cyst24cases of trigeminal neuralgia,13casesof meningioma,13cases of acoustic neuroma, herpes zoster in2cases, trigeminalschwannoma in2cases, skull bone tumor1case, nasopharyngeal carcinoma in1case, the left cerebellum arteriovenous malformation in1case. Surgical treatment of57casesof secondary trigeminal neuralgia patients were retrospectively analyzed the clinicaldata and follow-up. Sums up the gender, age, duration of disease, symptoms, signs,operation situation and postoperative pain relief and follow-up, etc.Results The group of57patients, a total of59times surgery, including2cases ofpostoperative recurrence of1year and2years later,2times surgery again, postoperativecurative effect is satisfied. Instant pain relief after treatment of52cases, there are3partial pain relief, the total effective rate was96.5%, and no relief in2cases (3.5%).1case of meningioma of the contralateral caused oppression, postoperative effect is good.Recurrence after tumor resection in1case, partial pain relief after tumor resection, afteraggravating and PMC therapy, pain relief; STN of acoustic neuroma,1case,postoperative recurrence2years PMC again, pain relief; STN of meningioma,1case,postoperative relapse1year PMC again, pain relief; Above two cases of recurrenceof follow-up has not seen. Another case of STN of meningioma after surgical operationto probe that risky failed to resection, and then changed to PMC, effect is satisfactory.Patients after treatment with mild ipsilateral hypoesthesia52cases, accounting for91.2%; ipsilateral limited mouth opening, masseter weakness,52cases (91.2%),symptoms improved more than l~3months disappear or tolerance, perioperativeconcurrent spat herpes7cases, accounted for12.3%, the recovery of1week or so. Nocorneal anesthesia and corneal reflection disappeared symptoms; The follow-up timewas10~99month, the average pain relief time of46months. As follow-up time9cases (15.8%), postoperative recurrence,symptoms of4underwent craniotomy aftertumor resection is disappeared,5cases with conservative medication can control thesymptoms. This group of patients hospitalized on average6.9days, and no seriouscomplications occurred.Conclusion1. For younger and atypical trigeminal neuralgia patients withpreoperative CT or MRI is necessary.2.PMC treatment of secondary trigeminalneuralgia is a very effective method of minimally invasive methods, for not suitable foror unwilling to surgical operation, through a variety of other methods of treatment is notideal, percutaneous procedures and postoperative recurrence of the STN craniotomysurgery patients, PMC is very worth considering.