AUTHOR=Zhi Dou , Guo Yuna , He Liangliang , Yang Liqiang 

TITLE=Percutaneous balloon compression of trigeminal ganglion under conscious sedation local anesthesia for the treatment of primary trigeminal neuralgia—A prospective cohort study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1144034

DOI=10.3389/fneur.2023.1144034

ISSN=1664-2295

ABSTRACT=Percutaneous balloon compression (PBC) is a proven treatment for trigeminal neuralgia. Due to the severe hemodynamic fluctuations that may be caused during puncture and balloon compression, general anesthesia is currently used worldwide to ensure the safety of surgery. However, under general anesthesia, the surgeon cannot learn the patient's feedback on the degree of hypoesthesia, so he can only rely on experience to set the balloon pressure and compression time. The consequence of this situation is that many patients cannot achieve the desired degree of nerve damage, which ensures long-term pain relief without causing excessive numbness. We achieved PBC under conscious sedation local anesthesia by improving the details of the surgical procedure. In the case of intraganglionic administration of lidocaine 0.2% with fine needle aspiration, the operator can know the degree of nerve damage in real time through the tactile test, so that the patient can achieve the ideal treatment effect. In our clinical observation of 87 patients, all patients achieved immediate relief of facial pain after surgery. Moreover, the intraoperative blood pressure and heart rate changes were less than 20% of the baseline value, and no patient experienced severe facial numbness. No patient developed irreversible keratitis, vision loss, or masticatory muscle weakness. Therefore, we believe that PBC under wide-awake local anesthesia is an ideal treatment for trigeminal neuralgia