Balloon Compression for TN

In an older article, I wrote about the benefits and drawbacks of microvascular decompression. Microvascular decompression is a procedure in which the patient's head is opened up to reveal the trigeminal nerve near the cerebellum; oftentimes, if the nerve pain is caused by pressure from a proximal blood vessel, a sponge is placed between the nerve and the vessel to distance the sensitive cells from the throbbing vessel. Balloon compression is similar to this treatment in that it also involves accessing the trigeminal nerve through an opening in the skull, but instead of trying to preserve the nerve by separating it from the offending blood vessel, the goal of the procedure is to damage it mechanically so it no longer transmits painful signals.

Thus, this procedure- compared to other surgical options- has a negative connotation because it damages rather than restores the nerve. However, this should not be the primary reason a patient shies away from the procedure; indeed, the procedure is generally successful, can be performed on a variety of patients, and is cost-effective. Of course, as with any surgical procedure, there are side effects- some of which are greater for balloon compression.

But what is the procedure like? As mentioned above, balloon compression is a rhizotomy, which means it is performed to damage the nerve. Specifically, this occurs at the point near the base of the skull where the nerve splits into its three "branches." A benefit of balloon compression is that, considering it is a surgical procedure, the process is relatively non-invasive: while the patient is under general anesthesia, the doctor inserts a hollow needle (a tube called a "cannula") through the cheek. The hollow cannula allows the doctor to thread a soft catheter with a balloon tip towards the nerve at the base of the skull. Once there, the balloon is inflated to press the nerve against the skull and the dura, which covers the brain, mechanically damaging the nerve. The balloon is only inflated for about a minute, then it is removed (with the cannula). The procedure in its entirety takes only about 20 min, so it is generally an outpatient procedure. Although considered non-invasive for a surgery (there are very few side effects associated with the actual procedure or general anesthesia), it is nevertheless a final alternative for patients who have not had success with their medication for trigeminal neuralgia.

Unfortunately, because the nerve is being damaged and not preserved, there are side effects. Balloon compression offers only a small chance of losing sensation permanently, but many patients develop at least temporary weakness (especially in the jaw, for chewing) and facial numbness is more severe with this procedure than with other rhizotomy procedures. In fact, masseter (chewing) muscle weakness is practically guaranteed, although new procedures are being developed which employ a shorter compression time and more monitoring during surgery (Brown and Pilitsis), to help reduce muscle weakness. And unfortunate corollary of this development is that, while it does successfully control pain, in many cases the pain has recurred. Yet, there is no procedure which does guarantee against recurrent pain among trigeminal neuralgia patients, so balloon compression is actually a very viable option, particularly as a non-invasive surgical alternative for patients with recurrent pain after microvascular decompression.

Other positive aspects of balloon compression are its cost-effectiveness and the fact that it works well for patients suffering with other coexisting health conditions. Because it only requires general anesthesia and exposes no other nerves, it has few negative interactions with other treatments. Lastly, if the nerve pain cannot be pinpointed, or if it is caused by something other than pressure from a proximal vessel, stopping the nerve signals with balloon compression would be more helpful than microvascular decompression (particularly if the doctor can find no offending blood vessel during the MVD procedure).