Percutaneous balloon compression followed by perineural methylprednisolone for trigeminal neuralgia: A 50-patient retrospective series with 12-month outcomes.

OBJECTIVE

To describe pain outcomes and safety after a combined protocol of percutaneous balloon compression (PBC) followed immediately by perineural methylprednisolone in adults with pharmacoresistant trigeminal neuralgia.

METHODS

We conducted a multicentre, single-arm, retrospective observational series without a control cohort, including 50 consecutive patients with classical unilateral trigeminal neuralgia treated between January 2020 and January 2025. Procedures used Hartel's trans-oval approach under biplanar fluoroscopy with 60-120-s compression, followed immediately by perineural methylprednisolone acetate (20-40 mg). Follow-up was scheduled at 1 week, 1 month, 6 months, and 12 months. The primary outcome was pain control by Barrow Neurological Institute (BNI) pain class; secondary outcomes included VAS change and categorical VAS (0-3/4-6/7-10), patient satisfaction, and procedure-related adverse events.

RESULTS

Pain relief was marked early, but durability was limited over time. BNI I-II was achieved by 60% at 1 week and 56% at 1 month, decreasing to 34% at 6 months and only 32% at 12 months. Accordingly, by 12 months, 31/45 patients (69%) met our prespecified recurrence criteria and/or no longer had durable good pain control. Mean VAS improved from 9.0 ± 0.6 pre-procedure to 2.5 ± 1.2 (1 week), 3.0 ± 1.5 (1 month), 4.5 ± 2.0 (6 months), and 5.5 ± 2.2 (12 months). Improvements versus baseline were statistically significant at all time points (p ≤ 0.001). Adverse events were mainly sensory: mild hypoesthesia (44%) and transient masticatory weakness (20%); no serious adverse events were recorded.

CONCLUSION

In this retrospective single-arm series, a combined protocol of PBC followed by perineural methylprednisolone was associated with rapid early pain relief, attenuation of benefit by 12 months, and an acceptable safety profile. Because no comparator group was included, the incremental value of methylprednisolone beyond standard PBC cannot be determined. These findings should therefore be regarded as exploratory and hypothesis-generating and support prospective controlled studies comparing PBC with and without adjunct steroid.