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<p>To compare the long-term efficacy and safety of repeat microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with recurrent trigeminal neuralgia (TN) after initial MVD. Comprehensive clinical baseline characteristics, surgical details, and postoperative follow-up information were systematically collected. Propensity score matching was employed using sex, age, and follow-up time for 1:1 matching. The primary outcome was pain recurrence. Secondary outcomes included bothersome facial numbness, defined as a Barrow Neurological Institute (BNI) facial numbness score of III or higher, and poor overall outcome, defined as a composite BNI score (sum of the BNI pain intensity and facial numbness scores) of V or higher. Univariate and multivariate Cox proportional hazards and logistic regression models were employed to assess factors associated with pain recurrence and secondary outcomes, respectively. In this multi-center, retrospective, propensity-score-matched cohort study, the matched cohort comprised 286 patients (143 pairs) with recurrent TN after prior MVD. After excluding 30 patients lost to follow-up and 8 because of treatment failure, the final analysis included 127 patients who underwent repeat MVD and 121 treated with PBC. The two procedures demonstrated comparable long-term pain control. The pain recurrence rate was 16.5% in the repeat MVD group and 14.9% in the PBC group (<i>p</i> = 0.720), and the median pain-free survival was 53.0 months versus 58.0 months (<i>p</i> = 0.192). However, PBC was associated with a significantly higher incidence of bothersome facial numbness (24.8% vs. 8.7%, <i>p</i> = 0.001) and masticatory dysfunction (24.5% vs. 8.4%, <i>p</i> &lt; 0.001). Multivariable analysis confirmed that the choice of surgical procedure was not an independent predictor associated with pain recurrence (Hazard Ratio [HR], 0.714; 95% Confidence Interval [CI], 0.363–1.404; <i>p</i> = 0.329). For patients with recurrent TN after MVD, both repeat MVD and PBC provide comparable pain control, but differ significantly in risk profiles. PBC avoids craniotomy but is associated with higher rates of facial numbness and masticatory dysfunction. The optimal choice should be individualized based on patient health status, risk aversion, and preference for sensory preservation.</p>

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Outcomes of repeat microvascular decompression versus percutaneous balloon compression for recurrent trigeminal neuralgia

  • 期刊论文

  • 发表日期：

    2026年4月7日

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  • Ziyi Zhang,
  • Jiancong Weng,
  • Quancai Wang,
  • Xiaoli Xu,
  • Jitao Ding,
  • Yu Duan,
  • Hanlin Liu,
  • Ke Yang,
  • Yue Yuan,
  • Li Zhang,
  • Jiang Liu,
  • Yanbing Yu

摘要

To compare the long-term efficacy and safety of repeat microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with recurrent trigeminal neuralgia (TN) after initial MVD. Comprehensive clinical baseline characteristics, surgical details, and postoperative follow-up information were systematically collected. Propensity score matching was employed using sex, age, and follow-up time for 1:1 matching. The primary outcome was pain recurrence. Secondary outcomes included bothersome facial numbness, defined as a Barrow Neurological Institute (BNI) facial numbness score of III or higher, and poor overall outcome, defined as a composite BNI score (sum of the BNI pain intensity and facial numbness scores) of V or higher. Univariate and multivariate Cox proportional hazards and logistic regression models were employed to assess factors associated with pain recurrence and secondary outcomes, respectively. In this multi-center, retrospective, propensity-score-matched cohort study, the matched cohort comprised 286 patients (143 pairs) with recurrent TN after prior MVD. After excluding 30 patients lost to follow-up and 8 because of treatment failure, the final analysis included 127 patients who underwent repeat MVD and 121 treated with PBC. The two procedures demonstrated comparable long-term pain control. The pain recurrence rate was 16.5% in the repeat MVD group and 14.9% in the PBC group (p = 0.720), and the median pain-free survival was 53.0 months versus 58.0 months (p = 0.192). However, PBC was associated with a significantly higher incidence of bothersome facial numbness (24.8% vs. 8.7%, p = 0.001) and masticatory dysfunction (24.5% vs. 8.4%, p < 0.001). Multivariable analysis confirmed that the choice of surgical procedure was not an independent predictor associated with pain recurrence (Hazard Ratio [HR], 0.714; 95% Confidence Interval [CI], 0.363–1.404; p = 0.329). For patients with recurrent TN after MVD, both repeat MVD and PBC provide comparable pain control, but differ significantly in risk profiles. PBC avoids craniotomy but is associated with higher rates of facial numbness and masticatory dysfunction. The optimal choice should be individualized based on patient health status, risk aversion, and preference for sensory preservation.