Spinal Injury Guidelines

Spinal cord injury guidelines

Summary of the evidence

Clinical practice recommendations

Balloon microcompression may be considered for the treatment of adults with trigeminal neuralgia for whom medical (and, where appropriate, psychosocial) management has failed (C).

What is balloon microcompression?

Balloon microcompression is a technique used to apply pressure to the trigeminal nerve to change the way it transmits pain. The trigeminal nerve carries sensation and pain fibres from the face to the brain.

What conditions is balloon microcompression used for in the studies appraised?

  • Idiopathic trigeminal neuralgia that is not adequately controlled by medical management.
  • Facial pain related to multiple sclerosis.

How is balloon microcompression done?

The procedure is carried out under general anaesthetic. Under X-ray guidance, a needle is passed to the hole where the trigeminal nerve passes into the skull. A catheter with a small balloon at the end is passed through this needle. The balloon is then inflated just inside the skull to compress the nerve ganglion.

Where is balloon microcompression done?

Balloon microcompression is carried out in a hospital operating room or radiology department with access to an operating room.

Who does balloon microcompression?

The procedure is only carried out by a neurosurgeon.

How effective is balloon microcompression?

One systematic review, one comparative study and one observational study provided information on the effectiveness of balloon microcompression for trigeminal neuralgia.

The review (Lopez et al. 2004) included one uncontrolled study (n=50) on balloon microcompression for trigeminal neuralgia that reported complete pain relief in 86% of patients at one year follow-up and 69% at three years. The authors concluded that more work is required to determine the effectiveness of balloon microcompression. In the comparative study (Braun et al. 1996) the results of balloon microcompression (n=24) were compared with those of two other treatments for trigeminal neuralgia. It was not clear how the patients were selected for each intervention and it was therefore not appropriate to compare the results directly. All patients treated once with balloon microcompression for idiopathic trigeminal neuralgia (n=7) or multiple sclerosis-related facial pain (n=4) had long term success. In the observational study (Lobato et al. 1990, n=144), 90% of patients with trigeminal neuralgia (predominantly idiopathic) did not have recurrence of symptoms at last follow-up (between 10 and 35 months).

How safe is balloon microcompression?

Adverse effects following balloon microcompression were reported in the above-mentioned studies and in five additional lower quality studies not included in the evaluation of effectiveness. Commonly reported adverse effects included hypoaesthesia/hypoalgesia in 78 to 100% of patients (“marked hypoaesthesia” in 4% of patients in one study) and weakness / atrophy of masseter muscle in 25% to “almost all” patients. Other less frequently reported adverse effects included transient reduction in corneal reflex in “most” patients, asymmetrical mastication in 12% of patients, and meningitis, transient diplopia or troublesome dysaesthesia in smaller numbers of patients.

Reviewed: 16 March 2015