Is the Occurrence of Bradycardia During Percutaneous Balloon Compression for Trigeminal Neuralgia a Clinical Prognostic Indicator?

Background: Trigeminal ganglion percutaneous balloon compression (PBC) for treating trigeminal neuralgia (TN) is favored for its high success rate and minimal complications. During PBC, significant hemodynamic changes can occur, leading to sudden bradycardia, asystole, or rapid blood pressure increase, collectively known as the trigeminocardiac reflex (TCR). Isolated bradycardia during PBC is common. Despite this, mortality risk is very low, with bradycardia becoming critical in few patients. This unknown mechanism might indicate effective compression on Gasser's ganglion, crucial for clinical response in treating TN. Methods: An observational study of TN patients who underwent PBC was performed at a neurosurgical unit. The outcome was to assess prognostic impact of bradycardia during PBC and investigate clinical factors for its occurrence. Results: A total of 123 patients were included, divided into 2 groups: the bradycardia group (n = 35) and the normal frequency group (n = 88). An excellent outcome (BNI I-II) was achieved in 45% of patients in Group 1 and in 34% of patients in Group 2 (P = 0.05). The mean pain-free survival (PFS) duration was significantly longer in the bradycardia group (26 vs. 13 months, P = 0.017). Stable efficacy of pain relief was found in the bradycardia group throughout the follow-up period. Conclusion: Patients who manifested bradycardia demonstrated greater clinical efficacy with a superior Pain outcome and PFS compared with the normal-frequency group with an independent clinical outcome with respect to obtaining pear-shape and time of compression. This finding could be considered as an important prognostic factor.