Analysis Of The Efficacy Of Percutaneous Balloon Compression By Puncture The Oval Hole In Treating Primary Trigeminal Neuralgia

ObjectiveThis article collects case data of patients with primary trigeminal neuralgia treated by percutaneous puncture the oval hole balloon compression,summarizes its efficacy,related factors and complications affecting the efficacy,and explores the clinical application value of this operationmethodA total of 116 patients with primary trigeminal neuralgia who were treated from April 2018 to December 2019 in the functional nerve group of the First Affiliated Hospital of Kunming Medical University were collected.All patients underwent PBC surgery and received telephone or outpatient follow-up.Records separately.The postoperative curative effect and related complications of the patients were statistically analyzed based on the postoperative curative effect of the pati ent's age,gender,pain distribution area,duration of disease,previous surgical history,balloon shape and other factors.Results(1)A total of 116 PTN patients were treated with PBC in this group,of which 106 patients had complete relief of postoperative pain,5 patients had delayed remission,3 patients had complete relief of pain on the second day after surgery,and two other patients were observed in hospital for one week The pain was all relieved.4 patients was significantly improved.The balloon shape of these 4 patients was pear-like.All 4 patients had radiofrequency ablation in the past.During the PBC operation,the operator felt that the puncture process was significantly difficult.Repeated adjustment of the puncture needle failed.Satisfactory pear shape was obtained.Because the operation time is too long and the trigeminal nerve suppression response repeatedly occurs during the operation,the surgeon chooses a pear-like compression for 2 minutes when the balloon shape is not adjusted satisfactorily.The pain range,severity and frequency of postoperative pain were higher in 4 patients than before surgery.Three patients had significant pain relief,and no oral medication was required.The effectiveness of PBC in the treatment of PTN is as high as 100%.Among them,112 cases(96.6%)completely relieved pain,and 4 cases(3.4%)improved significantly.No patient had recurrence of pain during follow-up.The results of statistical analysis showed that:PBC surgery The postoperative effect had no significant effect on the patient's age,gender,pain distribution area,duration of disease,and previous surgery history(P>0.05).The shape of the balloon had a significant effect on the postoperative efficacy of PTN patients,which was statistically significant(X=87.01,P<0.001).(2)Of the 116 patients with PTN treated with PBC,80(69.0%)patients experienced varying degrees of trigeminal nerve reflex during puncture and balloon compression,of which 3 patients had cardiac arrest and stopped during intraoperative procedures.Heart rate returned to normal.Installing a pacemaker or intravenous atropine before surgery can reduce the occurrence of trigeminal nerve reflex.Postoperative numbness was very common in patients,and 101(90.2%)patients experienced varying degrees of numbness.BNI facial numbness score was used to classify the degree of numbness.There were 58 patients with mild facial numbness,58 with mild numbness,and 43 with moderate numbness.During the follow-up process,we found that the patient's facial numbness would follow The postoperative period became longer and gradually reduced,and almost all patients with mild facial numbness disappeared after 3 months.Sixty-seven patients(57.8%)had weakness in the chewing muscles of the affected side after PBC.Follow-up observation showed that the symptoms gradually recovered one month after the operation,and the chewing muscle strength of the patients basically returned to normal after 2-3 months.Oral herpes is also very common,with a total of 42 cases(36.2%),most of which occurred from 1 to 3 days after surgery.The patient was given topical acyclovir ointment,which improved after about 1-2 weeks of follow-up observation.There were two cases of temporary diplopia after PBC without other special treatment.Follow-up observation showed that both patients disappeared after 3 weeks.Postoperative swelling and pain of the lateral side,this symptom occurred in 11 patients in this group of cases,of which 9 patients had repeated adjustment of the puncture needle because of the unsatisfactory balloon shape,and more consideration was given to soft tissue contusion and swelling or subcutaneous small blood vessel rupture during repeated puncture Symptoms were relieved after 1-3 days of cold compress on ice towel.No severe complications such as weakened corneal reflex,intracranial hematoma,intracranial infection,cerebrospinal fluid leakage,internal carotid fistula,etc.were found in this group of cases,nor were there any cases of death or disability.Conclusion1.Percutaneous balloon compression by puncture the oval hole for primary trigeminal neuralgia is a surgical method with high cure rate and very safe operation.2.The shape of the balloon has a significant effect on the postoperative effect of PBC.When the balloon is in the shape of a pear during operation,the postoperative effect of patients with PTN is significantly higher than that of patients with pear-like shape.