Factors that influence outcome of percutaneous balloon compression in the treatment of trigeminal neuralgia.
ABSTRACT Percutaneous balloon compression is an effective, low-cost, simple therapeutic modality with the special advantage of being the only percutaneous technique that can be simply performed with the patient under general anesthesia for the treatment of trigeminal neuralgia.
To identify surgical and individual parameters that could influence outcome in patients with trigeminal neuralgia treated with percutaneous balloon compression.
Within a 5-year period, 66 consecutive percutaneous balloon compressions were performed in 47 patients. The medical and surgical records of all patients were retrospectively reviewed and analyzed for a possible correlation between the following parameters and outcome: balloon shape, balloon volume, compression time, age, sex, type of pain, duration of disease, previous procedures, and trigeminal division affected. Univariate and multivariate analyses were used to test for statistical significance.
The initial success rate was 85%, and 36% of the responders are still pain free with a mean follow-up of approximately 20 months, whereas in 33 patients, trigeminal pain recurred after a mean of approximately 17 months. Of the investigated parameters, significant correlations were obtained between balloon shape and all aspects of outcome, previous operations and complication rate, pain type and complication rate, and compression time and postoperative numbness.
The balloon shape is a parameter with a very strong impact on outcome, and balloon volume should be adjusted to this parameter. Persistent elliptical balloon shapes should raise consideration of aborting the procedure. There were no differences in outcomes between 60 seconds and longer compression times. The number of previous operations did not correlate with pain relief, but seemed to increase the risk of complications. Patients with multiple sclerosis seemed to obtain similar benefit from the procedure as do patients with classic trigeminal neuralgia.
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ABSTRACT: OBJECTIVE: Drug-resistant trigeminal neuralgia (TN) can complicate the clinical course of patients affected by multiple sclerosis (MS). Various surgical procedures have been reported for the treatment of this condition, but there is no agreement on the best management of these patients. To our knowledge, there is no critical literature analysis focusing on this particular topic. The aim of this study was to evaluate the clinical outcome of different surgical procedures utilized for drug-resistant TN in MS patients. METHODS: We reviewed the literature about the studies reporting on surgical treatment of drug-resistant TN in MS patients. Case reports and case series less than 4 patients were excluded from the analysis. Nineteen studies were selected for the statistical analysis. To reduce the variability of the data, the selected studies were evaluated for the following outcome parameters: acute pain relief rate (APR), rate of recurrence (RR), pain free at follow-up rate (PF at FU) and complication rate (CR). For the statistical analysis, chi-square statistic, using the Fisher's exact test was utilized. RESULTS: There was no procedure statistically superior in terms of APR rate in MS patients following the surgical treatment of TN. The highest RR was observed for percutaneous balloon compression (PBC) (60.2±14.4%). This result was statistically significant when compared to gamma knife surgery (GKS) (p=0.0129) and microvascular decompression (MVD) (p=0.0281). MVD together with percutaneous radiofrequency rhizothomy (PRR) was associated with a statistically better PF at FU rate (56.5±16.8% and 73.5±14.2%, respectively). However PBC and MVD showed statistical significant minor CR compared to other techniques (no complications and 18.7±17.4%, respectively). CONCLUSION: Our study shows no differences in the short term results among different procedures for TN in MS patients. Each technique demonstrate advantages and limits in terms of long term pain, recurrence rate and complication rate. Each patient should be accurately informed on pros and cons of each procedure in order to be involved in the most appropriate choice.Clinical neurology and neurosurgery 07/2012; 115(5). DOI:10.1016/j.clineuro.2012.07.011 · 1.25 Impact Factor
Conference Paper: Theoretical study of 3 dimensional hysteresis PWM techniques[Show abstract] [Hide abstract]
ABSTRACT: In this paper, the theoretical study and comparison between the a-b-c hysteresis PWM technique which is proposed at 1997 and 3 dimensional (α-β-0) hysteresis PWM which is proposed at 1998 are performed for 3-phase 4-wire 3-leg center-split power quality compensators. There is description on DC voltage variation control in the a-b-c hysteresis PWM technique, however, no description of DC voltage variation and no determination of error bands are performed for 3-dimensional (α-β-0) hysteresis one. In this paper, a novel 3-D hysteresis control is proposed with DC voltage control by the concept of keeping the same overall error bounded volume with higher the DC control ability.Power Electronics and Motion Control Conference, 2004. IPEMC 2004. The 4th International; 09/2004
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ABSTRACT: Trigeminal neuralgia is rarely caused by arteriovenous malformations of the posterior fossa. Embolization of aberrant vessels can provide symptomatic relief; however, embolization is not always technically possible, and its effects can be temporary. Embolization of the nerve's blood supply could reduce its excitability and provide pain relief. The study was set in an academic tertiary care center. The study was designed as a report of a clinical case. The authors report the case of a 13-year-old girl with a large, unruptured posterior fossa arteriovenous malformation (AVM) presented with left-sided V2-division trigeminal neuralgia. She had undergone multiple previous embolizations of feeding vessels from the anterior inferior cerebellar artery with temporary relief of her symptoms. Embolization of the middle meningeal artery was attempted, but the vessel's tortuosity precluded safe catheterization. Instead, the artery of the foramen rotundum, which had minimal contribution to the AVM nidus, was embolized with Onyx copolymer. The patient had immediate cessation of her neuralgia, with a small area of hypesthesia above her left cheek. Complete pain relief lasted for 8 months, followed by a return of mild dysesthesia episodes not requiring intervention. This case may represent a new method of palliative treatment for AVM-associated trigeminal neuralgia, or potentially trigeminal neuralgia of other etiologies. Based on this case's success, a prospective study using additional provocative testing with intraarterial lidocaine is proposed.Pain Medicine 11/2011; 12(12):1824-30. DOI:10.1111/j.1526-4637.2011.01277.x · 2.24 Impact Factor