Secondary Trigeminal Neuralgia (Balloon Compression Rhizolysis)

Multiple sclerosis is a common secondary cause of trigeminal neuropathic pain. It occurs because of the presence of sclerotic plaque within the highly myelinated trigeminal pathway. Patients with multiple sclerosis (MS) may also have a vascular compressive etiology; however, the two-year success rate for microvascular decompression is merely 15%. Ablative treatment also has a high pain recurrence rate that is as high as 50% in one year regardless of the surgical option selected. Balloon compression rhizotomy is a simple treatment option in MS patients. When done, the balloon compression site is at the retrogasserian portion of the trigeminal nerve and not the trigeminal ganglion. Balloon compression is associated with a trigeminal depressor response for which one must be prepared to treat with iv atropine.