Percutaneous Balloon Gasserian Ganglion Rhizolysis (PBG) for Trigeminal Neuralgia (TN) is an affordable and minimally invasive treatment option known for its effectiveness in managing this debilitating facial pain condition. Despite its reported efficacy, there exists a gap in evidence regarding the factors predisposing certain patients to treatment failure and subsequent necessity for retreatment. 

A comprehensive review of existing literature was conducted and the search encompassed databases including PubMed, Europe PMC, SCOPUS, and the Cochrane Library up to May 1, 2024, following the guidelines outlined in PRISMA. Eligible studies focused on TN patients diagnosed through clinical examination and/or imaging studies, who received PBG treatment. Emphasis was placed on studies reporting both radiographic and clinical outcomes post-PBG with a prerequisite for publication in English and full-text accessibility. Excluded were case reports, case series, reviews, editorials, conference abstracts, studies with insufficient data, overlapping patient cohorts or secondary TN arising from conditions such as multiple sclerosis or tumors. All included studies were assessed using Newcastle Ottawa Scale.

We found that predictors associated with the need for retreatment in patients with TN who underwent PBG included treatment response, duration of pain relief, anatomical variations in the trigeminal nerve, and underlying conditions. Shorter durations of pain relief post-PBG often correlated with the necessity for retreatment. Anatomical irregularities like vascular compression were found to have potentially affected PBG efficacy and contributed to retreatment requirements.

Approximately, third of patients undergoing PBG require retreatment. This observation suggests that early trigeminal nerve neuronal plasticity changes, potentially leading to neuropathic pain, may contribute to retreatment necessity. Further investigations are warranted to validate these findings, which could potentially influence the future management strategies for TN.