Trigeminal Neuralgia: Indications of Gasserian Ganglion Gompression With Balloon Catheter in the Modern Era - Trigeminal Neuralgia: Indications of Gasserian Ganglion Gompression With Balloon Catheter in the Modern Era - Open Access Pub

Many therapies are available for trigeminal neuralgia (TN), from medical therapy to invasive, mininvasive and non-invasive methods. There is no a unique indication concerning the choice of treatment; we report our indications for gasserian ganglion compression with balloon by percutaneous approach. Out of 421 patients affected by TN treated with various methods from 2004 through to 2014, we present 46 patients treated by gasserian ganglion compression with balloon catheter. Patients selected for this procedure were only those refractory to medical therapy and refractory to the other available therapies (radiofrequency, microvascular decompression, radiosurgery, glycerolization, peripheral alcoholizations): balloon compression was performed as third line therapy. After the procedure, twenty-eight patients were classified as BNI pain intensity score grade 1, seven other as grade 2, three other as grade 3, six were classified as BNI grade 4, and in one patient no improvement of pain occurred (BNI grade 5). After an average period of follow up of 8,6 years, four cases of pain recurrence occurred. Because balloon compression is an ablative and non-selective procedure and all three trigeminal divisions are damaged to achieve stable pain remission, the procedure was performed only in patients affected by recurrent TN refractory to the other available methods. DOI10.14302/issn.2688-5328.ijp-19-2804 Trigeminal neuralgia (TN) is a social disabling disease and nowadays still represents a therapeutic challenge 1, 2, 3. In general, many therapeutic options are available for TN, from invasive (microvascular decompression 4, mininvasive 5, 6, 7, 8, 9 and non invasive (Radiosurgery/Hypofractionated radiotherapy 10, 11, 12 ones. Usually, medical therapy with carbamazepine represents the first therapeutic choice 13 and when it is ineffective or patients are intolerant, the above-mentioned methods are employed. Based on the available literature, when medical therapy is ineffective, it is evident that the choice between the various therapeutic methods is not well established, and it depends mainly from operator’s familiarity with one or another technique and from the technological devices available in the center where the patient is referred to. We observed that only few authors 3, and only partially, selected one or another procedure according to patients (advanced age, medical conditions) and neuralgia (trigeminal division, gravity of neuralgia) characteristics. Concerning 421 patients affected by trigeminal neuralgia refractory to medical therapy treated with various