The Analysis Of Fatal And Disabling Complications Of Percutaneous Microballoon Compression In Treatment For Primary Trigeminal Neuralgia

Objective: Primary Trigeminal Neuralgia(PTN) is a normal Cranial nerve disease.It is the paroxysmal and periodic pain in the area dominated by the brain fifth nerve when attacks, once known as “the worst pain in the world”. The treatment to diease is various, each method can alleviate the pain to a certain extent, but there are complications and limitations either. Percutaneous Microballoon Compression(PMC/PBC) is an effective surgical way in the treatment of trigeminal neuralgia. Since first used to treat PTN by Professor Mullan in 1980 s, it has a rapid devolopment in decades, and admired and recognized by the domestic and foreign neurosurgeons because of its short general anesthesia time, simple operation, less complications and short-term recovery. We retrospectively evaluated the severe cerebral vascular complications and potentially fatal and disabling trigeminal depressor responses in 1362 patients with PTN who underwent PMC to explore the general characteristics of patients, the followed serious complications and its treatments.Meanwhile, we analyze possible factors causing complications in order to provide the basis for the prevention and treatment of postoperative or in-operative complications in the future.Methods: Retrospectively analyze 1362 patients with primary trigeminal neuralgia who underwent percutaneous microballoon compression. All the patients were given the general blood, heart and lung function examination to exclude the blood and heart or lung disease, the CT or MRI examination to exclude the secondary factors.In the end, statistically analyze all the severe cerebral vascular complications andtrigeminal depressor responses arise in operation or postoperation.Results: There are 580 males and 782 males in all the 1362 cases of the study;591patients with left operation, 771 patients with right operation; the maximum age is 90,the minimum age is 19 years old, the mean age is 57.18 years old; the shortest duration of symptom is 4 months, the longest duration of symptom is up to 360 months, the mean duration of symptom is 84.69 months; 354 patients with hypertension,191 patients with heart disease, 95 patients with diabetes.There are 4 cases of cerebral vascular complications in 1362 cases: 1 case of brain stem hemorrhage, conservative treatment, the patient was announced the death in 3hours after the operation; 1 case of subdural hemorrhage, urgent craniotomy intracranial hematoma with decompressive craniectomy after diagnosed by CT, now the patient is still in a deep coma in ICU though his vital signs all are stable; 1 case of arteriovenous fistula, interventional embolization after appears of symptom, now the patient is cured; 1 case of internal carotid artery hemorrhage when puncturing in operation, suspend operation and compress hemostasis, the patient had a success second operation after 2 weeks-recovery from first operation.There are 1207 cases of trigeminal depressor responses in 1362 cases. The main performance is bradycardia(mean decreasing rate is 23 / min), with short time of intraoperative blood pressure drop. 14 patients experience a transient cardiac arrest, but all recovery after stoping operation.Conclusion:1. Before the PMC treatment to PTN, general blood, heart and lung function,CT or MRI examination is essential to exclude risk factors which may cause severe complications postoperation or in-operation.2. Most complications after PMC are mild, and recovery in a certain period of time, the incidence of cerebrovascular complications is rare, but once appears, careful medical treatments are needed.3. The possible reasons of cerebrovascular complications are patients with chronic disease such as hypertension, close relationship between vascular and nerve,the deviation of needle when puncturing, Intraoperative hypotension and Postoperative hypertension.4. It is difficult to avoid trigeminal depressor responses in operation. The reasons maybe the compression of microballoon, light anesthesia or the drugs used by patients pre-operation. Although no severe cases appear, it is still a potential fatal and disabling factor.5. In general, PMC is a good choice for patients whose conservative treatment is invalid, but intolerant or unwilling to have craniotomy operation.