Analysis of recurrence factors after balloon compression for trigeminal neuralgia and the relationship between pear-shaped balloon and guidewire path

Background: Percutaneous balloon compression (PBC) is widely used to treat trigeminal neuralgia due to its significant efficacy and low treatment cost. However, there is considerable variation in postoperative pain recurrence among patients. Currently, the factors influencing pain recurrence after PBC are under discussion. This study aims to explore the impact of individual patient parameters and surgical parameters on postoperative pain recurrence following PBC. The goal is to provide clinicians with a reference for preoperative assessment of pain recurrence risk and to offer insights for effectively intervening in controllable influencing parameters. Methods: A analysis was conducted on 114 patients who underwent PBC in the Department of Neurosurgery at Hebei General Hospital. Univariate Kaplan-Meier analysis and multivariate Cox regression analysis were performed on the general and surgical data of the patients to identify factors potentially associated with postoperative pain recurrence. Results: The results of the multivariate Cox regression analysis showed that a history of hypertension, MRI indicating trigeminal nerve compression and a non-ideal pear-shaped balloon were statistically significant factors for pain recurrence after PBC. Additionally, the guidewire path during the procedure had a statistically significant impact on the rate of achieving a pear-shaped balloon (P<0.05). Conclusion: A history of hypertension, MRI indicating trigeminal nerve compression and a non-ideal pear-shaped balloon shape are independent risk factors for pain recurrence after PBC. Additionally, to avoid pain recurrence due to an unfavorable balloon shape, it is recommended to use 3D-slicer for preoperative guidewire path simulation and 3D reconstruction of Meckel's cavity.