Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
J Neurosurg. 2010 Sep;113(3):486-92. doi: 10.3171/2010.1.JNS091106.
The aim of this study was to compare percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizotomy (PRGR) in terms of effectiveness, complications, and technical aspects.
Sixty-six consecutive PBC procedures were performed in 45 patients between January 2004 and December 2008, and 120 PRGR attempts were performed in 101 patients between January 2006 and December 2008. The PRGR procedures were not completed due to technical reasons in 19 cases. Five patients in the Balloon Compression Group and 9 patients in the Glycerol Group were lost to follow-up and were excluded from the study. The medical records and the intraoperative fluoroscopic images from the remaining cases were retrospectively examined, and the follow-up was completed with telephone contact, when necessary. The 2 groups were compared in terms of initial effect, duration of effect, and rates of complications as well as severity and type of complications.
The rates for immediate pain relief were 87% for patients treated with glycerol injection and 85% for patients treated with balloon compression. The Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence time was 21 months for the balloon procedure and 16 months for the glycerol procedure. When the groups were broken down by the "previous operations" criterion, the 50% recurrence time was 24 months for the Glycerol First Procedure Group, 6 months for the Balloon First Procedure Group, 8 months for the Glycerol Previous Procedures Group, and 21 months for the Balloon Previous Procedures Group. The rates of complications (excluding numbness) were 11% for PRGR and 23% for PBC, and this difference was statistically significant (chi-square test, p = 0.04).
Both PRGR and PBC are effective techniques for the treatment of trigeminal neuralgia, with PRGR presenting some advantages in terms of milder and fewer complications and allowing lighter anesthesia without compromise of analgesia. For these reasons the authors consider PRGR as the first option for the treatment of trigeminal neuralgia in patients who are not suitable candidates or are not willing to undergo microvascular decompression, while PBC is reserved for patients in whom the effect of PRGR has proven to be short or difficult to repeat due to cisternal fibrosis.
本研究旨在比较经皮球囊压迫（PBC）和经皮后根甘油注射切断术（PRGR）在疗效、并发症和技术方面的差异。
2004 年 1 月至 2008 年 12 月期间，45 例患者接受了 66 例连续的 PBC 手术，2006 年 1 月至 2008 年 12 月期间，101 例患者接受了 120 例 PRGR 尝试，但由于技术原因，19 例 PRGR 手术未完成。球囊压缩组中有 5 例和甘油组中有 9 例患者失访，被排除在研究之外。回顾性检查了其余病例的病历和术中荧光透视图像，并在必要时通过电话联系完成了随访。比较了两组的即刻止痛效果、效果持续时间以及并发症的发生率和严重程度及类型。
甘油注射组的即时止痛率为 87%，球囊压迫组为 85%。两种治疗方法的 Kaplan-Meier 图相似。球囊手术的 50%复发时间为 21 个月，甘油手术为 16 个月。当按“既往手术”标准对两组进行分组时，甘油初次手术组的 50%复发时间为 24 个月，球囊初次手术组为 6 个月，甘油既往手术组为 8 个月，球囊既往手术组为 21 个月。并发症发生率（不包括麻木）为 PRGR 组 11%，PBC 组 23%，差异有统计学意义（卡方检验，p=0.04）。
PRGR 和 PBC 都是治疗三叉神经痛的有效方法，PRGR 具有并发症较轻、较少，麻醉较轻而不影响镇痛的优点。因此，作者认为 PRGR 是不适合微血管减压术或不愿意接受微血管减压术的三叉神经痛患者的首选治疗方法，而 PBC 则保留给那些 PRGR 效果证明短暂或难以重复的患者，因为这些患者的脑池纤维化。
