The Role of Neuron-specific Enolase as a Biomarker of Response in Percutaneous Balloon Compression for Drug-Resistant Trigeminal Neuralgia

BACKGROUND AND OBJECTIVES: Neuron-specific enolase (NSE) has been identified as a marker of neuronal damage in different clinical conditions. Percutaneous balloon compression (PBC) is a well-established palliative destructive procedure for the treatment of trigeminal neuralgia (TN). The aim of our study was to evaluate the prognostic role of NSE in predicting pain recurrence after PBC for drug-resistant TN. METHODS: We retrospectively analyzed the prospectively collected data of 41 drug-resistant TN patients (21 M, 20 F; mean age 65 ± 13 years) who underwent PBC between December 2020 and June 2023. Serum levels of NSE and other biochemical parameters were collected preoperatively and postoperatively. Clinical factors, including age, sex, TN duration, pain type and side, previous operations, balloon morphology, were assessed. Outcomes included acute pain relief, recurrence rate, and Barrow Neurological Institute pain score at follow-up (FU). RESULTS: Of the 41 patients, 37 (90.2%) achieved acute pain relief. Barrow Neurological Institute pain score was significantly decreased at FU (median 19.00 [12.75-30.25] months) compared with the preoperative one (2.00 [1.00-3.00] and 4.00 [4.00-5.00], respectively; P < .0001). No major complications occurred in the whole cohort. Pain recurrence was observed in 17 patients (41.5%). Postoperative NSE levels significantly increased compared with preoperative levels ( P = .0301) especially in patients without recurrence ( P = .0057). Using receiver operating characteristic curve analysis, the following cutoff values were identified: Patients with postoperative NSE >10.5 ng/mL or perioperative (postoperative minus preoperative) NSE increase >0.5 ng/mL had significantly reduced recurrence rates ( P = .0004 and P = .0004, respectively). Multivariable analyses confirmed postoperative NSE value and perioperative NSE increase as independent negative predictors of pain recurrence ( P = .0420 and P = .0308). CONCLUSION: This study identified NSE as a key biomarker for predicting pain recurrence after PBC for drug-resistant TN. We identified clinically relevant cutoff values for postoperative NSE and perioperative NSE increase, which provide practical tools for risk stratification, allowing personalized FU strategies.