Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 725 Albany St 7th Floor, Suite 7C, Boston, MA, USA.
Neurosurg Rev. 2024 Nov 29;47(1):877. doi: 10.1007/s10143-024-03099-0.
Percutaneous balloon ganglyolysis (PBG) for trigeminal neuralgia (TN) is an inexpensive and minimally invasive treatment modality that is effective and safe. While there are reports of its efficacy, there is still a lack of evidence of which patients are at a higher risk of treatment failures and needing retreatment. We performed a retrospective study at a major academic institution from 2012 to 2023, including TN patients who underwent PBG procedures to evaluate predictors of retreatment. Patients without imaging available from the PBG were excluded. Fifty-two patients who underwent 83 procedures in total were included in the analysis. All patients had typical TN and were primarily female (59.6%), with a median age of 61.5 years. Immediately after PBG, 42.3% had pain resolution, and 57.7% had improved but persistent pain. 30.8% underwent retreatment with PBG in a median of 32 months. From multiple factors assessed, TN disease duration ≤ 6 months and trigeminal nerve enhancement on pre-operative MRI were identified as significant retreatment predictors on univariate analysis. However, after performing logistic regression, only TN disease duration ≤ 6 months remained significant OR 3.99 (95% CI 1.59-10.0; p = 0.003). This was further confirmed in a Kaplan-Meier survival analysis, which showed that patients with TN duration ≤ 6 months require retreatment earlier (22 vs. 41 months; p = 0.01). Retreatment after PBG occurs roughly in a third of patients, and TN disease duration of ≤ 6 months is an important predictor in this study. Further studies should be performed to confirm these findings, which may impact treatment considerations in the future.
经皮球囊神经切断术（PBG）治疗三叉神经痛（TN）是一种廉价且微创的治疗方法，具有有效性和安全性。虽然有关于其疗效的报道，但仍缺乏关于哪些患者更有可能治疗失败和需要再次治疗的证据。我们在一所主要学术机构进行了一项回顾性研究，时间范围为 2012 年至 2023 年，纳入了接受 PBG 治疗的 TN 患者，以评估再次治疗的预测因素。排除了没有 PBG 影像资料的患者。共有 52 名患者接受了 83 次治疗，分析中包括这些患者。所有患者均有典型的 TN，主要为女性（59.6%），中位年龄为 61.5 岁。PBG 后立即，42.3%的患者疼痛缓解，57.7%的患者疼痛改善但仍持续存在。30.8%的患者在中位时间为 32 个月后再次接受 PBG 治疗。在评估的多种因素中，单因素分析显示 TN 疾病持续时间≤6 个月和术前 MRI 上三叉神经增强是再次治疗的显著预测因素。然而，在进行逻辑回归后，只有 TN 疾病持续时间≤6 个月仍然是显著的预测因素，OR 为 3.99（95%CI 1.59-10.0；p=0.003）。Kaplan-Meier 生存分析进一步证实了这一点，表明 TN 持续时间≤6 个月的患者更早需要再次治疗（22 个月 vs. 41 个月；p=0.01）。PBG 后再次治疗的患者约占三分之一，本研究中 TN 疾病持续时间≤6 个月是一个重要的预测因素。应进行进一步的研究来证实这些发现，这可能会影响未来的治疗考虑。
