Application of Intraoperative Awake Anesthesia and Three-Dimensional Reconstruction Technique in Percutaneous Microballoon Compression for Trigeminal Neuralgia.

Objective: To examine the role of intraoperative awake anesthesia and the three-dimensional reconstruction technique in percutaneous microballoon compression (PBC) for the treatment of trigeminal neuralgia.

Methods: Seventy patients diagnosed with trigeminal neuralgia and admitted to Guangdong Sanjiu Brain Hospital from 2019 to 2022 were selected for the study.All patients were treated with PBC by three-dimensional (3D) reconstruction of preoperative and intraoperative images and intraoperative awake anesthesia. The duration of balloon compression during surgery was three minutes.After balloon compression during the procedure, the patient is awakened for effect assessment, allowing for real-time adjustments of the surgical strategy based on the evaluation.Postoperative pain relief was evaluated using the Brisman criteria.

Results: Pain completely disappeared immediately post-operation in 68 patients, and was significantly alleviated in two patients, with an efficacy rate of 100% and a cure rate of 97.1%. 60 patients experienced facial numbness on the affected side postoperatively, which showed different degrees of remission or disappearance within 6-12 months after surgery. Eleven cases of herpes labialis (15.7%), one case of facial hematoma (1.4%), and three cases of postoperative psychiatric symptoms (4.3%) occurred, all of which recovered within 1-2 weeks after surgery. Weakness in the masticatory muscles on the affected side was observed in four patients (5.7%), and all cases returned to normal within six months post-surgery.During follow-up 36-60 months, there were five cases (7.1%) of pain recurrence on the affected side.

Conclusion: Awake anesthesia combined with 3D reconstruction technology for PBC surgery may provide a safer and more effective alternative for the treatment of trigeminal neuralgia.