Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: A prospective systematic study using independent assessors

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 197-208 ◽  
Author(s):  
Tone Bruvik Heinskou ◽  
Per Rochat ◽  
Stine Maarbjerg ◽  
Frauke Wolfram ◽  
Jannick Brennum ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Odds Ratio ◽  
Morphological Changes ◽  
Outcome Data ◽  
Excellent Outcome ◽  
Classical Trigeminal Neuralgia ◽  
Male Sex ◽  
Symptomatic Side

Introduction There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16–16.26), p = 0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12–59.52), p = 0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration. Conclusion Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.

Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

Cephalalgia ◽  
2020 ◽  
pp. 033310242097435
Author(s):  
Navid Noory ◽  
Emil Andonov Smilkov ◽  
Jette Lautrup Frederiksen ◽  
Tone Bruvik Heinskou ◽  
Anne Sofie Schott Andersen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Odds Ratio ◽  
Morphological Changes ◽  
3.0 Tesla ◽  
Classical Trigeminal Neuralgia ◽  
Mri Scans ◽  
Low Prevalence ◽  
Headache Center ◽  
Symptomatic Side

Introduction A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS. Methods We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist. Results Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002). Conclusion The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS. The study was registered at ClinicalTrials.gov (number NCT04371575)

Microvascular decompression for trigeminal neuralgia in elderly patients

2008 ◽  
Vol 108 (4) ◽  
pp. 689-691 ◽  
Author(s):  
Raymond F. Sekula ◽  
Edward M. Marchan ◽  
Lynn H. Fletcher ◽  
Kenneth F. Casey ◽  
Peter J. Jannetta
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Outcome Data ◽  
Control Group ◽  
Younger Patients ◽  
Telephone Interviews ◽  
Second Tier

Object Although microvascular decompression (MVD) for patients with medically refractory trigeminal neuralgia (TN) is widely accepted as the treatment of choice, other “second-tier” treatments are frequently offered to elderly patients due to concerns regarding fitness for surgery. The authors sought to determine the safety and effectiveness of MVD for TN in patients older than 75 years of age. Methods The authors performed a retrospective review of medical records and conducted follow-up telephone interviews with the patients. The outcome data from 25 MVD operations for TN performed in 25 patients with a mean age of 79.4 years (range 75–88 years) were compared with those of a control group of 25 younger patients with a mean age of 42.3 years (range 17–50 years) who underwent MVDs during the same 30-month period from July 2000 to December 2003. Results Initial pain relief was achieved in 96% of the patients in both groups (p = 1.0). There were no operative deaths in either group. After an average follow-up period of 44 and 52 months, 78 and 72% of patients in the elderly and control groups, respectively, remained pain free without medication (p = 0.74). Conclusions Microvascular decompression is an effective treatment for elderly patients with TN. The authors' experience suggests that the rate of complications and death after MVD for TN in elderly patients is no different from the rate in younger patients.

A Comparison of Percutaneous Radiofrequency Trigeminal Neurolysis and Microvascular Decompression of the Trigeminal Nerve for the Treatment of Tic Douloureux

Neurosurgery ◽  
1977 ◽  
Vol 1 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Ronald I. Apfelbaum
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Sensory Loss ◽  
Tic Douloureux ◽  
Suboccipital Craniectomy ◽  
Early Results ◽  
Classical Trigeminal Neuralgia

Abstract In a 36-month period, 103 consecutive patients have been treated for classical trigeminal neuralgia with either percutaneous radiofrequency trigeminal neurolysis (PTN) (48 patients) or microvascular decompression (MVD) via a suboccipital craniectomy (55 patients). The results of these two procedures are tabulated, emphasizing especially the complications that have occurred with each. Successful initial relief of pain was achieved in 88% of the patients with PTN and 96% of the patients with MVD. Two significant complications occurred in the former group. Severe recurrences have occurred to date in 13% of the patients with PTN and in 5% of those with MVD. It is concluded that both procedures are effective, but that microvascular decompression offers the advantage of avoiding sensory loss and associated dysesthetic sensations. Follow-up is too short to conclude that MVD is a curative procedure, but the early results are very encouraging.

Microvascular Transposition Without Teflon: A Single Institution's 17-Year Experience Treating Trigeminal Neuralgia

2021 ◽  
Vol 20 (4) ◽  
pp. 397-405
Author(s):  
Andrew R Pines ◽  
Richard J Butterfield ◽  
Evelyn L Turcotte ◽  
Jose O Garcia ◽  
Noel De Lucia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Postoperative Pain ◽  
Trigeminal Neuralgia ◽  
Fibrin Glue ◽  
Microvascular Decompression ◽  
Inclusion Criteria ◽  
Kaplan Meier ◽  
Trigeminal Nerve Root

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.

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

2008 ◽  
Vol 32 (1) ◽  
pp. 87-94 ◽  
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

Onyx™ Cast Fragmentation After Embolization of Endoleaks

2021 ◽  
pp. 152660282110457
Author(s):  
Christopher Keegan ◽  
Symeon Lechareas ◽  
Francesco Torella ◽  
Tze Yuan Chan ◽  
Robert Fisher ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Endovascular Aneurysm Repair ◽  
Outcome Data ◽  
Single Fracture ◽  
Electronic Patient Records ◽  
Primary Success ◽  
Aneurysm Growth ◽  
Aneurysm Repair

Purpose: Endoleaks are common following endovascular aneurysm repair (EVAR), and the liquid embolic material Onyx has been widely used in their treatment. We report our experience of long-term morphological changes of Onyx casts on surveillance imaging. Materials and Methods: We identified 10 patients over 10 years who underwent Onyx embolization in our institution. Morphological changes of Onyx casts were assessed on surveillance radiographs and computed tomography (CT) scans. Relevant outcome data and sequelae were obtained via electronic patient records. Results: Twelve procedures were performed on 10 cases, 9 for type 2, and 1 for a type 1a endoleak. Five cases showed evidence of Onyx fragmentation on follow-up imaging ranging from a single fracture to gross fragmentation with migration of fragments. Of these 5, 3 had achieved primary success but 2 went on to develop recurrence of endoleak. Onyx volume ranged from 4 to 46.5 ml (median 10.5 ml) per patient with larger volumes demonstrating the most marked fragmentation on follow-up. Follow-up ranged from 9 months to 8 years (median 2.25 years). Conclusion: To our knowledge, this is the first report of Onyx fragmentation after endoleak embolization. If long-term morphological stability of the Onyx cast is necessary to maintain aneurysm seal, then Onyx may not offer a permanent solution to some patients with post-EVAR endoleaks. Our study cannot ascertain whether the observed changes were the cause or the effect of ongoing aneurysm growth, persistent endoleak, and/or other forces acting on the solidified polymer, but it raises important questions on the use of Onyx in this setting.

scholarly journals Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 86 (2) ◽  
pp. 182-190 ◽  
Author(s):  
Katherine Holste ◽  
Alvin Y Chan ◽  
John D Rolston ◽  
Dario J Englot
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Disease Duration ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Superior Cerebellar Artery ◽  
Drug Resistant ◽  
Pain Outcomes

Abstract BACKGROUND Microvascular decompression (MVD) is a potentially curative surgery for drug-resistant trigeminal neuralgia (TN). Predictors of pain freedom after MVD are not fully understood. OBJECTIVE To describe rates and predictors for pain freedom following MVD. METHODS Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed, Cochrane Library, and Scopus were queried for primary studies examining pain outcomes after MVD for TN published between 1988 and March 2018. Potential biases were assessed for included studies. Pain freedom (ie, Barrow Neurological Institute score of 1) at last follow-up was the primary outcome measure. Variables associated with pain freedom on preliminary analysis underwent formal meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for possible predictors. RESULTS Outcome data were analyzed for 3897 patients from 46 studies (7 prospective, 39 retrospective). Overall, 76.0% of patients achieved pain freedom after MVD with a mean follow-up of 1.7 ± 1.3 (standard deviation) yr. Predictors of pain freedom on meta-analysis using random effects models included (1) disease duration ≤5 yr (OR = 2.06, 95% CI = 1.08-3.95); (2) arterial compression over venous or other (OR = 3.35, 95% CI = 1.91-5.88); (3) superior cerebellar artery involvement (OR = 2.02, 95% CI = 1.02-4.03), and (4) type 1 Burchiel classification (OR = 2.49, 95% CI = 1.32-4.67). CONCLUSION Approximately three-quarters of patients with drug-resistant TN achieve pain freedom after MVD. Shorter disease duration, arterial compression, and type 1 Burchiel classification may predict more favorable outcome. These results may improve patient selection and provider expectations.

P3649Analysis of clinical and angiographic parameters as predictors of recurrent vasospastic angina

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J.-H Park ◽  
G.-S Yoon ◽  
S.-H Choi ◽  
Y S Beak ◽  
S W Kwan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Odds Ratio ◽  
Troponin I ◽  
Medication Compliance ◽  
Provocation Test ◽  
Vasospastic Angina ◽  
P Value ◽  
Kaplan Meier ◽  
Male Sex

Abstract Background Patients with vasospastic angina (VA) may have recurrent chest symptoms and life-threatening arrhythmias. Despite regular medications, many VA patients experience recurrent episodes of VA. In this study, we evaluate clinical and angiographic predictors of recurrent VA. Patients and methods From January 2010 to May 2018, a total of 858 patients who underwent ergonovine provocation test were retrospectively reviewed. We excluded the patients who had negative results of provocation test, follow up duration less than 1 month and poor medication compliance. The recurrent-VA group consisted of patients who were re-hospitalized, visited the emergency room, or had repeated coronary angiographies because of chest pain. Results A total of 858 patients who underwent ergonovine provocation tests between January 2010 to May 2018 were retrospectively reviewed. Of them, 162 (mean follow-up duration, 3.0 years) were eligible for our study. The patients were divided into two groups: recurrent-VA (n=33, 20.4%) and stable-VA groups (n=129, 79.6%). Compared with the stable-VA group, the recurrent-VA group consisted mostly of men (93.9% vs. 75.2%, P=0.01), and had low LDL-cholesterol levels (93±27 mg/dl vs. 108±31 mg/dl, P=0.01). In the angiographic findings, a degree of coronary artery disease (CAD) and the site and number of spasm-positive vessels showed no difference between the two groups. Nicorandil was more frequently prescribed at discharge in the stable-VA group (15.2% vs. 35.7%, P=0.02). In the multivariate analysis, the male sex (odds ratio [OR], 5.87; 95% confidence interval [CI], 1.31–26.22; P=0.02) and non-use of nicorandil (OR, 3.51; 95% CI, 1.25–9.84; P=0.01) were the independent predictive factors in the recurrent-VA group. In the Kaplan-Meier analysis, men who did not use nicorandil (n=85, 52.5%) had higher incidences of recurrent angina compared to the other group (n=77, 47.5%). (30.6% vs. 6.6%; p<0.001). Univariate and multivariate analysis Refractory VA (n=33) Stable VA (n=129) Odds ratio [95% CI] P value univariate Odds ratio [95% CI] P value multivariate Age <56 years, n (%) 20 (66) 58 (44) 1.88 [0.86–4.10] 0.11 NA NS Male sex, n (%) 31 (93.9) 97 (75.2) 5.11 [1.15–22.56] 0.03 5.87 [1.31–26.22] 0.02 Smoking, n (%) 17 (51.5) 46 (35.7) 1.91 [0.88–4.14] 0.09 NA NS No AMI presentation, n (%) 11 (33.3) 25 (19.4) 2.08 [0.89–4.84] 0.08 NA NS Troponin-I >0.86 ng/ml, n (%) 2 (7.1) 3 (2.7) 2.74 [0.43–17.27] 0.08 NA NS LDL-C <105 mg/dl, n (%) 21 (63) 58 (49) 1.81 [0.81–4.01] 0.14 NA NS No use of nicorandil, n (%) 5 (15.2) 46 (35.7) 3.10 [1.12–8.58] 0.02 3.51 [1.25–9.84] 0.01 Kaplan-Meier curves Conclusions Male sex and non-use of nicorandil were independent predictors of recurrent VA.

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