Long-term evaluation of clinical outcome after microvascular decompression for trigeminal neuralgia – Langzeitauswertung der klinischen Ergebnisse nach mikrovaskulärer Dekompression bei Trigeminusneuralgie

Abstract BACKGROUND Trigeminal neuralgia (TN) refractory to medical management is often treated with microvascular decompression (MVD) involving the intracranial placement of Teflon. The placement of Teflon is an effective treatment, but does apply distributed pressure to the nerve and has been associated with pain recurrence. OBJECTIVE To report the rate of postoperative pain recurrence in TN patients who underwent MVD surgery using a transposition technique with fibrin glue without Teflon. METHODS Patients were eligible for our study if they were diagnosed with TN, did not have multiple sclerosis, and had an offending vessel that was identified and transposed with fibrin glue at our institution. All eligible patients were given a follow-up survey. We used a Kaplan-Meier (KM) model to estimate overall pain recurrence. RESULTS A total of 102 patients met inclusion criteria, of which 85 (83%) responded to our survey. Overall, 76 (89.4%) participants responded as having no pain recurrence. Approximately 1-yr pain-free KM estimates were 94.1% (n = 83), 5-yr pain-free KM estimates were 94.1% (n = 53), and 10-yr pain-free KM estimates were 83.0% (n = 23). CONCLUSION Treatment for TN with an MVD transposition technique using fibrin glue may avoid some cases of pain recurrence. The percentage of patients in our cohort who remained pain free at a maximum of 17 yr follow-up is on the high end of pain-free rates reported by MVD studies using Teflon. These results indicate that a transposition technique that emphasizes removing any compression near the trigeminal nerve root provides long-term pain-free rates for patients with TN.

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TRIGEMINAL NERVE RADIOSURGICAL TREATMENT IN INTRACTABLE CHRONIC CLUSTER HEADACHE

Neurosurgery ◽

10.1227/01.neu.0000245612.86484.7 ◽

2006 ◽

Vol 59 (6) ◽

pp. 1252-1257 ◽

Cited By ~ 22

Author(s):

Anne Donnet ◽

Manabu Tamura ◽

Dominique Valade ◽

Jean Régis

Keyword(s):

Trigeminal Neuralgia ◽

Cluster Headache ◽

Trigeminal Nerve ◽

Chronic Cluster Headache ◽

High Rate ◽

Long Term Results ◽

Complete Relief ◽

Term Evaluation ◽

The One

Abstract OBJECTIVE We have previously reported short-term results of a prospective open trial designed to evaluate trigeminal nerve radiosurgical treatment in intractable chronic cluster headache (CCH). Medium- and long-term results have not yet been reported. METHODS Ten patients presenting with a severe and drug-resistant CCH were enrolled (nine men, one woman). The radiosurgical treatment was performed according to the technique usually used for trigeminal neuralgia in our department. A single 4-mm shot was positioned at the level of the cisternal portion of the trigeminal nerve. The median distance between the center of the shot and the emergence of the nerve was 9.35 mm (range, 7.5–13.3 mm). The median of this maximum dose to the brainstem was 8.0 Gy (range, 4.0–11.1 Gy). Mean age was 49.8 years (range, 32–77 yr). Mean duration of the CCH was 9 years (range, 2–33 yr). The mean follow-up period was 36.3 months (range, 24–48 mo). RESULTS Two patients had complete relief of CCH. One patient had a good result with evolution in an episodic form. Seven patients had no improvement. Nine patients developed a new trigeminal nerve disturbance: three developed paresthesia with no hypoesthesia and six developed hypoesthesia, including two patients with deafferentation pain. Only one patient had neither paresthesia nor hypoesthesia. CONCLUSION We confirmed, with medium- and long-term evaluation, the high rate of toxicity and failure of the technique. The high toxicity, despite a methodology identical to the one used in trigeminal neuralgia, leads us to suspect an underlying specificity of the nerve in CCH. We do not recommend radiosurgery for treatment of intractable CCH.

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Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

Neurosurgical Review ◽

10.1007/s10143-008-0171-3 ◽

2008 ◽

Vol 32 (1) ◽

pp. 87-94 ◽

Cited By ~ 37

Author(s):

Serdar Kabatas ◽

Aykut Karasu ◽

Erdinc Civelek ◽

Akin P. Sabanci ◽

Kemal T. Hepgul ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Surgical Management ◽

Microvascular Decompression ◽

Review Of The Literature ◽

Long Term Follow Up

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Long term efficacy and patient satisfaction of microvascular decompression and gamma knife radiosurgery for trigeminal neuralgia

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2014.11.028 ◽

2015 ◽

Vol 22 (5) ◽

pp. 818-822 ◽

Cited By ~ 25

Author(s):

Anil Nanda ◽

Vijayakumar Javalkar ◽

Shihao Zhang ◽

Osama Ahmed

Keyword(s):

Patient Satisfaction ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Microvascular Decompression ◽

Gamma Knife Radiosurgery ◽

Term Efficacy

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Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience

Acta Neurochirurgica ◽

10.1007/s00701-016-2911-4 ◽

2016 ◽

Vol 158 (11) ◽

pp. 2203-2206 ◽

Cited By ~ 1

Author(s):

Francesco Muratorio ◽

G. Tringali ◽

V. Levi ◽

G. K. I. Ligarotti ◽

V. Nazzi ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression

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The long-term outcome of microvascular decompression for trigeminal neuralgia

British Journal of Neurosurgery ◽

10.3109/02688690903370289 ◽

2010 ◽

Vol 24 (1) ◽

pp. 18-25 ◽

Cited By ~ 66

Author(s):

Zaid Sarsam ◽

Marta Garcia-Fiñana ◽

Turo J. Nurmikko ◽

Thelekat R. K. Varma ◽

Paul Eldridge

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Term Outcome ◽

Long Term Outcome

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Gamma Knife Radiosurgery for Primary and Secondary Trigeminal Neuralgia

Neurosurgery ◽

10.1093/neuros/nyz310_700 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Sunil K Gupta

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Treatment Modality ◽

Pain Control ◽

Treatment Options ◽

Gamma Knife Radiosurgery ◽

Clinical Criteria ◽

Grade Iii

Abstract INTRODUCTION Trigeminal neuralgia has always been a disease of conflict from pathological and management perspectives. Despite advances in the radiological imaging, evidence from autopsy studies, and intraoperative findings, concrete answers are not in sight. GKRS has been a strong contender among available treatment options for the management of trigeminal neuralgia. METHODS All patients were evaluated on clinical criteria, BNI scale for intensity of pain, and facial hypoesthesia (if any) in a protocol-based manner. Only patients with BNI III to V were offered GKRS as a treatment modality. The Marseille point was targeted with a 70 to 90 Gy dose at 50% isodose. Patients were informed about all available treatment options with long-term prognosis and pain control rates. Patients in need of an immediate pain relief, in failed GKRS, and in a severe pain jeopardizing routine life and eating habits were not offered GKRS and were managed with microvascular decompression. RESULTS A total of 108 (65 males, 43 females) patients received GKRS with the Perfexion model since 2009. Eighty-two percent of the patients received GKRS for primary trigeminal neuralgia, while the rest received GKRS for secondary trigeminal neuralgia due to skull base lesions (meningioma, schwannoma, cerebellar AVM, etc). A total of 78% of the patients had preoperative BNI scale IV, while 19% and 3% of the patients had grade III and V scale pain, respectively. Ninety-four percent patients gained BNI scale III intensity pain within 3 mo of GKRS. The 3-yr pain control rate (BNI I-II) could be attained in 81% of the patients. Twelve percent of the patients remained in BNI grade III. Two patients needed redo GKRS for their pain recurrence. CONCLUSION It remains uncontested that MVD provides the best long-term pain-free control in patients of trigeminal neuralgia; however, GKRS remains a valuable feasible option for a selected group of patients. GKRS should be offered as an alternative treatment modality in patients not in urgent need of pain relief. In failed GKRS, authors did not encounter any difficulty in microvascular decompression.

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