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).

Alternative (herbal) treatments for Neuralgia

Here is a short list of several herbal supplements that people have used to augment treatments for neuralgias. Keep in mind that few (actually, none that I could find) of these herbal remedies have been scientifically proven to aid neuralgia; they are on this list because I have encountered them in the course of researching possible neuralgia treatments. Additionally, all of the alternative treatments are most effective when used in conjunction with other, more conventional treatment courses (typically, a combination of herbal supplements and anticonvulsants or antidepressants).

1) Zanthoxylum clava-herculisis. Also known as "toothache tree," this spiny tree can reduce pain from a toothache because chewing on the bark or leaves numbs the teeth and tongue. It can be helpful for trigeminal neuralgia patients because of its "antispasmodic" properties for the face and mouth.

2) Matricaria recutita, commonly known as German Chamomile, is typically used to treat stomachache and IBS (Irritable Bowel Syndrome), because it is a mild laxative. It is also helpful for sleeping (hence the inclusion of chamomile in many "sleeping" teas), and is anti-inflammatory. Most importantly, in studies with animals the plant has exhibited anti- inflammatory and convulsant properties (as stated above, research is lacking to confirm similar results in humans).

3) Arctium lappa (Burdock) is traditionally used to treat respiratory disorders, joint pain and urinary problems by stimulating cell regeneration. It helps protect against cell damage and abnormal growth, but it is better applied to joint pain and sciatica, rather than neuralgia.

4) Harpagophytum procumbens (Devil's Claw) is also good for treating (chronic) joint pain. It contains harpagoside and beta-sitosterol, which have anti-inflammatory properties, and is good for chronic lower-back pain. Doloteffin is a standardized preparation of Devil's Claw. Unfortunately, Devil's Claw promotes the secretion of stomach acids, so side effects involve gastric complications such as ulcers and stomach discomfort.

5) Asperula odorata (sweet woodruff) also has anti-spasmodic and sedative effects.

Concerning the treatment of neuralgia, these supplements (although not tested in a loarge-scale, scientific setting) are good because they promote general health, and also tend to have minor side effects. Rare side effects include nausea and vomiting, as well as allergic reactions to chamomile (if you are allergic to pollen). Lastly, keep in mind that none of these treatments are specifically promoted as a means to aiding neuralgia- the properties they exhibit for other symptoms can likewise be helpful with certain forms of neuralgia.

Looking to purchase these alternative treatments? They should be available at most native remedy or herbal supplement stores. I looked online and had difficulty finding any "name brand," alternative products for neuralgia, although one product "SciatiGon" contains the first four supplements I mentioned above, and claims to reduce nerve pain, specifically for sciatica.