Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

2018 ◽  
Vol 96 (5) ◽  
pp. 305-310 ◽  
Author(s):  
Min Wu ◽  
Xiaofeng Jiang ◽  
Chaoshi Niu ◽  
Xianming Fu
Keyword(s):  
Trigeminal Neuralgia ◽  
Neurovascular Compression ◽  
Trigeminocardiac Reflex ◽  
Internal Neurolysis

127 A Novel Scoring System for Preoperative Prediction for Pain-Free Survival After Microsurgery for Trigeminal Neuralgia: TN-MVD Score

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-229 ◽  
Author(s):  
Frances Hardaway ◽  
Hanna Gustafsson ◽  
Katherine Holste ◽  
Kim J Burchiel ◽  
Ahmed M T Raslan
Keyword(s):  
Trigeminal Neuralgia ◽  
Scoring System ◽  
Cox Regression ◽  
Outcome Data ◽  
Neurovascular Compression ◽  
Neurovascular Conflict ◽  
Radiographic Findings ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Internal Neurolysis

Abstract INTRODUCTION Pain relief following microsurgery for trigeminal neuralgia (TN) may be related to multiple factors including pain type, degree of neurovascular conflict, arterial compression, and location of compression. The objective of this study was to construct a predictive scoring system based on clinical and radiographic factors that can preoperatively prognosticate long-term outcomes in TN following surgery. METHODS 275 patients with Type 1 or Type 2 TN underwent microvascular decompression (MVD) or internal neurolysis (IN) following a preoperative high-resolution MRI. Outcome data was obtained retrospectively by chart review and/or phone follow-up. Characteristics of neurovascular conflict were obtained from preoperative MRI. Factors that resulted in a probability value of <0.05 on univariate logistic regression analyses were entered into a multivariate cox regression analysis in a backward stepwise fashion. For the multivariate analysis, significance at the 0.15 level was used. A prognostic system was then devised with three possible scores (0/1, 2, or 3) and survival analyses were conducted. RESULTS >Univariate predictors of pain-free survival were pain type (P = 0.013), presence of any vessel (P = 0.042), and neurovascular compression severity (0.038). Scores of 0/1, 2, and 3 were found to be significantly different in regard to pain-free survival (log rank, P = 0.008). At 5 and 10 years there were 42, 57, and 72% and 42,52, and 58%, pain free survival in groups 0/1, 2, and 3, respectively. TN1 patients with severe neurovascular conflict (score of 3) had the best outcome, which was significantly better that TN1 patients without neurovascular conflict (score of 1) (log rank, P = 0.005). Severe neurovascular conflict is more likely to have arterial compression (99%) (P< 0.001). CONCLUSION Pain-free survival of TN patients after microsurgery can be predicted in a step-wise statistically significant fashion, by a simple scoring system based on preoperative clinical and radiographic findings.

scholarly journals Surgical Outcomes After Microvascular Decompression With Internal Neurolysis and Partial Neurectomy for Patients With Trigeminal Neuralgia and Negative Neurovascular Compression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amanda Carpenter ◽  
James K Liu
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Root Entry Zone ◽  
Internal Neurolysis ◽  
Facial Numbness

Abstract INTRODUCTION Microvascular decompression (MVD) is an effective and durable treatment for patients with trigeminal neuralgia (TN) due to neurovascular compression (NVC). In the absence of NVC, the traditional MVD is less effective in achieving long-term pain relief. Internal neurolysis at the root entry zone (REZ) of the trigeminal nerve has been described in the literature; however, there are few reports of long-term outcome after this procedure. Furthermore, this is the first study to combine this procedure with additional partial neurectomy. METHODS This is a retrospective review of the senior author's patients with TN who underwent retrosigmoid craniectomy for MVD with internal neurolysis and partial neurectomy. Primary indications were patients with TN and no evidence of NVC intraoperatively. A total of 9 patients were included in the analysis. Three cases were of recurrent TN. The technique was performed with an 11-blade or arachnoid knife to open the perineurium in a longitudinal fashion at the REZ. A disc dissector was used to comb the fascicles along the longitudinal course, and a partial neurectomy was performed with a microscissors to make three selective cuts into the fascicles at the REZ. Barrow Neurological Institute (BNI) facial pain and numbness scales were used as postoperative assessment. RESULTS At median follow up of 12 mo (range: 2 to 34), 8 of 9 patients (89%) had a BNI-pain score of I (no trigeminal pain, no medications). Two of nine patients (22%) had a BNI-numbness score of I (no numbness); seven (78%) had a BNI-numbness score of II (mild facial numbness that is not bothersome). CONCLUSION Internal neurolysis with partial neurectomy appears to be an effective and potentially durable treatment option for patients with TN (primary or recurrent) without NVC. Larger series with longer follow-up is indicated to further evaluate the utility of this procedure.

scholarly journals Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression

2015 ◽  
Vol 122 (5) ◽  
pp. 1048-1057 ◽  
Author(s):  
Andrew L. Ko ◽  
Alp Ozpinar ◽  
Albert Lee ◽  
Ahmed M. Raslan ◽  
Shirley McCartney ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Successful Outcome ◽  
Neurovascular Compression ◽  
Free Survival ◽  
Internal Neurolysis

OBJECT Trigeminal neuralgia (TN) occurs and recurs in the absence of neurovascular compression (NVC). While microvascular decompression (MVD) is the most effective treatment for TN, it is not possible when NVC is not present. Therefore, the authors sought to evaluate the safety, efficacy, and durability of internal neurolysis (IN), or “nerve combing,” as a treatment for TN without NVC. METHODS This was a retrospective review of all cases of Type 1 TN involving all patients 18 years of age or older who underwent evaluation (and surgery when appropriate) at Oregon Health & Science University between July 2006 and February 2013. Chart reviews and telephone interviews were conducted to assess patient outcomes. Pain intensity was evaluated with the Barrow Neurological Institute (BNI) Pain Intensity scale, and the Brief Pain Inventory–Facial (BPI-Facial) was used to assess general and face-specific activity. Pain-free survival and durability of successful pain relief (BNI pain scores of 1 or 2) were statistically evaluated with Kaplan-Meier analysis. Prognostic factors were identified and analyzed using Cox proportional hazards regression. RESULTS A total of 177 patients with Type 1 TN were identified. A subgroup of 27 was found to have no NVC on high-resolution MRI/MR angiography or at surgery. These patients were significantly younger than patients with classic Type 1 TN. Long-term follow-up was available for 26 of 27 patients, and 23 responded to the telephone survey. The median follow-up duration was 43.4 months. Immediate postoperative results were comparable to MVD, with 85% of patients pain free and 96% of patients with successful pain relief. At 1 year and 5 years, the rate of pain-free survival was 58% and 47%, respectively. Successful pain relief at those intervals was maintained in 77% and 72% of patients. Almost all patients experienced some degree of numbness or hypesthesia (96%), but in patients with successful pain relief, this numbness did not significantly impact their quality of life. There was 1 patient with a CSF leak and 1 patient with anesthesia dolorosa. Previous treatment for TN was identified as a poor prognostic factor for successful outcome. CONCLUSIONS This is the first report of IN with meaningful outcomes data. This study demonstrated that IN is a safe, effective, and durable treatment for TN in the absence of NVC. Pain-free outcomes with IN appeared to be more durable than radiofrequency gangliolysis, and IN appears to be more effective than stereotactic radiosurgery, 2 alternatives to posterior fossa exploration in cases of TN without NVC. Given the younger age distribution of patients in this group, consideration should be given to performing IN as an initial treatment. Accrual of further outcomes data is warranted.

scholarly journals Internal Neurolysis (Nerve Combing) for Trigeminal Neuralgia without Neurovascular Compression

2021 ◽  
Author(s):  
Marco Gonzales-Portillo ◽  
Luis Adrián Huamán
Keyword(s):  
Trigeminal Neuralgia ◽  
Pain Intensity ◽  
Surgical Outcomes ◽  
Neurovascular Compression ◽  
Pain Intensity Score ◽  
Kaplan Meier ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Group A ◽  
Group B

Abstract Objective The aim of the present study was to describe and evaluate the initial and the long-term clinical outcome of internal neurolysis (IN) for trigeminal neuralgia (TN) without neurovascular compression (NVC). Methods A total of 170 patients diagnosed with TN were treated by posterior fossa exploration, during the period between April 2012 and October 2019. The patients were divided into two groups: Group A (50 patients) was treated by IN and Group B (120 patients) received microvascular decompression (MVD). Surgical outcomes and postoperative complications were compared between the two groups. Pain intensity was assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. Pain recurrence was statistically evaluated with Kaplan-Meier analysis. Results Pain was completely relieved in 44 patients (88%) who underwent IN (group A); 3 (6%) experienced occasional pain but did not require medication (BNI 2). In group B, 113 (94%) experienced immediate pain relief after MVD. The median duration of follow-ups was 4 years (6 months to 7.5 years). In Group A, there was a meantime recurrence of 27 months in 3 patients (6%). The recurrence in Group B was of 5.8% during the follow-up period. There were no statistically significant differences in the surgical outcomes between the two groups. All patients with IN experienced some degree of numbness, 88% of the cases resolved in 6 months, on average. Conclusion Internal neurolysis is an effective, safe and durable treatment option for trigeminal neuralgia when NVC is absent.

scholarly journals Internal Neurolysis With and Without Microvascular Decompression for Trigeminal Neuralgia

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Victor Sabourin ◽  
Jacob Mazza ◽  
Tomas Garzon-Muvdi ◽  
Donald Yandong Ye ◽  
Anthony Stefanelli ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Case Series ◽  
Treatment Modalities ◽  
Low Grade ◽  
Neurovascular Compression ◽  
Salvage Procedure ◽  
Internal Neurolysis ◽  
Significant Difference

Abstract INTRODUCTION Trigeminal Neuralgia (TN) is a pain syndrome often resulting in debilitating, paroxysmal lancinating facial pain in various distributions. Microvascular decompression (MVD) is the mainstay surgical treatment when an offending vessel is identified. However, internal neurolysis (IN) or nerve-combing (NC) have become increasingly utilized as an adjunct or stand-alone therapy when low grade or no neurovascular compression (NVC) is identified intraoperatively, or as a salvage procedure in patients with TN unresponsive to MVD or other treatment modalities. METHODS A retrospective case series review was performed for patients with TN treated with IN, with or without MVD. An MVD was performed with IN when an offending vessel causing low grade compression was seen. If no NVC was identified, IN alone was performed. Twenty-three patients were identified with an average follow-up of 14.5 mo. The Barrow Neurologic Institute (BNI) Pain Scale and Hypesthesia Scale were used to determine outcomes. Additionally, a systematic review of the literature was performed for patients with TN treated with IN/NC with or without MVD. RESULTS The overall success of treatment with an average follow-up of 14.5 mo was 87%. There was no significant difference (P = .235) between rates of successful treatment for patients who had an MVD/IN versus IN alone, however there was a trend toward improved outcomes when MVD/IN were simultaneously performed; 93% MVD/IN versus 75% IN alone. The most common complication with IN was postoperative hypesthesia, however most patients (96%) had either no or mild non-bothersome hypesthesia at last follow-up. CONCLUSION IN with or without MVD represents a reasonable option for TN when low grade or no NVC is identified or as a salvage procedure when other modalities of treatment have failed.

MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling

2021 ◽  
pp. 028418512098397
Author(s):  
Yufei Zhao ◽  
Jianhua Chen ◽  
Rifeng Jiang ◽  
Xue Xu ◽  
Lin Lin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Predictive Model ◽  
Trigeminal Nerve ◽  
Roc Curve ◽  
Neurovascular Compression ◽  
Diagnostic Efficiency ◽  
Mri Features ◽  
Vascular Origin ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Characteristics

Background Multiple neurovascular contacts in patients with vascular compressive trigeminal neuralgia often challenge the diagnosis of responsible contacts. Purpose To analyze the magnetic resonance imaging (MRI) features of responsible contacts and establish a predictive model to accurately pinpoint the responsible contacts. Material and Methods Sixty-seven patients with unilateral trigeminal neuralgia were enrolled. A total of 153 definite contacts (45 responsible, 108 non-responsible) were analyzed for their MRI characteristics, including neurovascular compression (NVC) grading, distance from pons to contact (Dpons-contact), vascular origin of compressing vessels, diameter of vessel (Dvessel) and trigeminal nerve (Dtrigeminal nerve) at contact. The MRI characteristics of the responsible and non-responsible contacts were compared, and their diagnostic efficiencies were further evaluated using a receiver operating characteristic (ROC) curve. The significant MRI features were incorporated into the logistics regression analysis to build a predictive model for responsible contacts. Results Compared with non-responsible contacts, NVC grading and arterial compression ratio (84.44%) were significantly higher, Dpons-contact was significantly lower at responsible contacts ( P < 0.001, 0.002, and 0.033, respectively). NVC grading had a highest diagnostic area under the ROC curve (AUC) of 0.742, with a sensitivity of 64.44% and specificity of 75.00%. The logistic regression model showed a higher diagnostic efficiency, with an AUC of 0.808, sensitivity of 88.89%, and specificity of 62.04%. Conclusion Contact degree and position are important MRI features in identifying the responsible contacts of the trigeminal neuralgia. The logistic predictive model based on Dpons-contact, NVC grading, and vascular origin can qualitatively improve the prediction of responsible contacts for radiologists.

scholarly journals An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naureen Keric ◽  
Darius Kalasauskas ◽  
Sophia L. Kreth ◽  
Martin B. Glaser ◽  
Harald Krenzlin ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Age Groups ◽  
Treatment Strategies ◽  
The Elderly ◽  
Outcome Analysis ◽  
Neurovascular Compression ◽  
Duration Of Symptoms ◽  
Ganglion Gasseri

Abstract Background Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) presents an excellent treatment in neurovascular compression cases, percutaneous thermocoagulation (PT) of the ganglion Gasseri is an alternative option. This study aimed to evaluate post-operative complication rate and outcome of both treatment strategies related to the patient’s age. Methods The medical records of all patients with the diagnosis of trigeminal neuralgia undergoing an MVD or PT of the ganglion Gasseri (between January 2007 and September 2017) were reviewed to determine the efficacy and the complication rate of both methods in regard to the patient’s age. Results Seventy-nine patients underwent MVD surgery and 39 a PT. The mean age of patients in the MVD group was 61 years and 73 years in the PT group. There were 59 (50%) female patients. Nerve-vessel conflict could be identified in 78 (98.7%) MVD and 17 (43.6%) PT patients on preoperative MRI. Charlson comorbidity index was significantly higher in PT group (2.4 (1.8) versus 3.8 (1.8) p < 0.001). The Barrow pain score (BPS) at the last follow-up demonstrated higher scores after PT (p = 0.007). The complication rate was markedly higher in PT group, mostly due to the facial hypesthesia (84.6% versus 27.8%; p < 0.001). Mean symptom-free survival was significantly shorter in the PT group (9 vs. 26 months, p < 0.001). It remained statistically significant when stratified into age groups: (65 years and older: 9 vs. 18 months, p = 0.001). Duration of symptoms (OR 1.005, 95% CI 1.000–1.010), primary procedure (OR 6.198, 95% CI 2.650–14.496), patient age (OR 1.033, 95% CI 1.002–1.066), and postoperative complication rate (OR 2.777, 95% CI 1.309–5.890) were associated with treatment failure. Conclusion In this patient series, the MVD is confirmed to be an excellent treatment option independent of patient’s age. However, while PT is an effective procedure, time to pain recurrence is shorter, and the favorable outcome (BPS 1 and 2) rate is lower compared to MVD. Hence MVD should be the preferred treatment and PT should remain an alternative in very selected cases when latter is not possible but not in the elderly patient per se.

Sign in / Sign up

Export Citation Format

Share Document