Percutaneous Balloon Compression Procedure

Introduction

Percutaneous Balloon Compression (PBC) is a established, minimally invasive surgical procedure that is employed in the treatment of trigeminal neuralgia–a chronic nerve disorder which causes intense, sudden facial discomfort. This procedure is particularly suitable for patients who haven’t had a positive response to treatment or aren’t suitable candidates for more extensive procedures such as microvascular decompression (MVD).

With this article, we’ll go through the full process that is PBC surgery by describing the steps that occur prior to and after the procedure, as well in the manner surgeons perform it as well as the equipment utilized and the care for patients at every step.

1. Preoperative Preparation

Before the actual procedure there are several steps that are taken to ensure the patient’s safety and the success during the process.

a. Patient Evaluation :- A thorough medical evaluation is conducted by a neurosurgeon or neurologist. A doctor will confirm that the patient has trigeminal neuropathy and is usually supported with MRI as well as CT tests to determine other causes such as tumors or multiple sclerosis. The diagnosis must be correct since PBC is designed specifically to treat idiopathic or classic trigeminal neuralgia.

b. Medical Clearance :- Patients are subjected to basic health tests including ECG as well as blood tests as well as a review of medication (especially the blood thinners). If you’re on anticoagulants they may be stopped just a few days prior to surgery to decrease the risk of bleeding.

c. Informed Consent :- The surgeon discusses the potential risks, benefits and potential consequences of PBC. Consent is given when the patient is aware of the anticipated benefits as well as potential adverse effects like facial numbness, or even temporary jaw weakness.

2. Check-in at Surgical Facility

The day before the operation the patient is admitted into a surgery facility or hospital. The majority of PBC procedures are performed as outpatient procedures which means you return home the next day, unless complications occur.

A. Fasting :- Patients are advised not to consume any food or drink for approximately 6-8 hours prior to the procedure because of general anesthesia.

b. Preparation :- After admission after admission, an IV line is inserted for the administration of anesthesia as well as fluids. The vital signs are constantly monitored. The surgical site, which is usually the cheek region is washed and disinfected.

3. Anesthesia as well as Positioning

PBC is usually carried out in the presence of general anesthesia and the patient is asleep and pain-free during the procedure.

• The patient lies on their back, with the head slightly distended.

• A cushion or ring could be used to support the head.

• In some sophisticated setups there is an fluoroscopy system (real-time imaging with X-ray) is utilized to control the placement of needles as well as catheters.

4. Step-by-Step Surgical Method

We are now at the main part of the procedure, which is PBC procedure. The procedure typically takes 30-60 minutes to finish.

A. Needle Insertion :- A specially-designed spine needle (about 3.5 inches long) is carefully inserted into the cheek of the patient, and then directed towards an opening at the skull’s base known as the foramen ovale. This is the bony opening where the mandibular branch of the trigeminal nerve exits from the skull.

• By using fluoroscopic guidance, the surgeon makes sure that the needle’s tip is in an appropriate position in relation to the trigeminal (Gasserian) Ganglion.

• This ganglion is situated inside Meckel’s cave. It is a pouch that contains fluid inside the skull’s base.

b. Positioning of the Balloon Catheter :- When the needle is at the correct position when it is, it is then a thin catheter that has the balloon at its tip is inserted through the needle before being inserted through Meckel’s Cave. The surgeon will use imaging to verify whether the balloon was placed over the trigeminal ganglion.

C. Inflation on the Balloon :- This is the therapeutic part:

• The balloon is then inflated using an exact volume of contrast dye (visible under an X-ray) for an brief time, typically 60-120 minutes.

• Inflating the ganglion, it expands and damages the tiny, pain-conducting fibers but preserving the other nerve fibers involved in the sensation of touch and movement.

The balloon appears to form the shape of a “pear shape” in fluorescence, which is a sign of that it is compressed properly. Shape and dimension of the balloon are important for efficiency.

D. Deflation and removal :- After the compression time you want:

• The balloon has been deflated completely.

• The needle and catheter are taken off.

• A thin bandage is affixed at the site of insertion. No stitches are required.

5. Rehabilitation and Postoperative Care

After operation, patients are observed in a healing space for a short period of time. The majority of patients are discharged on the the same day.

a. Immediate Post-Surgery Symptoms :-The sensation of facial numbness is normal on the side that was treated it is a sign that the fibers of pain were weakened.

• Mild swelling, bruising or tenderness around the point where cheeks enter can occur.

• The relief from pain is usually instantaneous however, in certain instances, it could take several days.

b. Instructions for Home :- 

• Do not engage in strenuous activities for a period of 24 to 48 hours.

• Apply cold packs to help reduce swelling, if required.

• Use pain medication if prescribed however, most patients do not require them.

• Continue eating normally and brushing after numbness has subsided somewhat.

6. Side Effects and Risks

While PBC is among the safest surgical options available for trigeminal neuralgia, it is not without risk. potential adverse effects:

• Numbness in the Face :- Facial numbness is common after PBC surgery. It’s usually mild, not bothersome, and often fades over weeks or months as nerves gradually adjust to the treatment.
• Jaw Weakness :- Some patients experience temporary weakness or discomfort while chewing. This typically lasts a few days to weeks and improves with time and regular jaw movement during recovery.
• Double Vision :- Though extremely rare, brief double vision can occur due to nerve proximity. It generally resolves quickly and does not lead to permanent visual disturbances or long-term problems.
• Infection or Bleeding :- The minimally invasive, needle-based approach, the risks of infection or bleeding are very low. Proper sterilization and technique further reduce the chances of such complications.
• Recurrence of Pain :- Pain may return in 1–5 years post-surgery. However, PBC can be safely repeated, often with similar effectiveness in reducing trigeminal neuralgia symptoms without major long-term harm.

7. Efficiency of PBC

Clinical studies have demonstrated that PBC can provide relief from pain for 80-90 percent of patients particularly those who are not responding well to medication. Although relief may not last in every patient, many patients have long periods of pain-free living after just one session.

When pain is recurring it is possible to repeat the procedure. an option that is generally provides the same level of security and efficiency.

8. What is the reason? PBC is the preferred choice

• Perfect for patients who are elderly or those who suffer from medical conditions.

• It is less invasive than brain surgery.

• A short hospital stay and speedy recovery.

• There aren’t any large cuts or wounds.

• Repetition is possible without major problems.

Conclusion

Percutaneous Balloon Compression is a precise, minimally-invasive procedure that provides an effective treatment for the trigeminal neuralgia. It combines safety with high rates of success and is an ideal option for patients who aren’t suitable candidates for more extensive procedures. With a simple needle-based method, PBC compresses the problematic nerve fibers, usually providing instant relief from pain with a quick recovery time.

In the event that you, or a person you know suffers from the severe discomfort of trigeminal neuropathy, PBC could be the answer you need to get back to a pain-free, normal life.