Microvascular Decompression for Trigeminal Neuralgia: The Importance of a Noncompressive Technique— Kaplan-Meier Analysis in a Consecutive Series of 330 Patients

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS341-ONS351 ◽  
Author(s):  
Marc Sindou ◽  
José M. Leston ◽  
Evelyne Decullier ◽  
François Chapuis
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Consecutive Series ◽  
Cure Rate ◽  
Kaplan Meier ◽  
Group I ◽  
Cerebellar Artery ◽  
Significant Difference ◽  
Group Ii

Abstract Objective: Microvascular decompression, although a well-established procedure for treating primary trigeminal neuralgia, still has no standardized protocol. The practical consequences of having the implant keep the conflicting vessels apart, whether or not in contact with the root, is still in debate. The present work was undertaken to answer this question. Methods: Patients were segregated into 2 groups: Group I (260 patients) had a Teflon prosthesis implanted without contact to the root, and Group II (70 patients) had a similar implant with contact to the root. Cure rates in the 2 groups were compared at the latest follow-up (≤15 yr; average, 8.2 yr) using Kaplan-Meier analysis. Results: In Group I, the cure rate was 82% (214 of 260 patients), whereas in Group II, the cure rate was 67% (47 of 70 patients) (P = 0.01). Kaplan-Meier analysis of the follow-up period up to 15 years also shows a significant difference (P = 0.05). Conclusion: These results strongly support the goal of performing the procedure without the implant in contact with the root. This is easier with the superior cerebellar artery, because of its laxity and small number of perforating branches, than with the anteroinferior cerebellar artery, which has perforators to the brainstem and labyrinthine artery arising from its cisternal portion. The significantly better long-term cure rate when the implant is not in contact with the root favors the “pure” decompressive effect of the microvascular decompression procedure, rather than a conduction block mechanism.

scholarly journals Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm

2013 ◽  
Vol 34 (3) ◽  
pp. E3 ◽  
Author(s):  
Xuhui Wang ◽  
Parthasarathy D. Thirumala ◽  
Aalap Shah ◽  
Paul Gardner ◽  
Miguel Habeych ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Botulinum Neurotoxin ◽  
Lateral Spread ◽  
Safe Procedure ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group Ii

Object The objective of this study was to investigate the clinical characteristics, intraoperative findings, complications, and outcomes after the first microvascular decompression (MVD) in patients with and without previous botulinum neurotoxin treatment for hemifacial spasm (HFS). Methods The authors analyzed 246 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000, and December 31, 2007. One hundred and seventy-six patients with HFS underwent botulinum neurotoxin injection treatment prior to first MVD (Group I), and 70 patients underwent their first MVD without previous botulinum neurotoxin treatment (Group II). Clinical outcome data were obtained immediately after the operation, at discharge, and at follow-up. Follow-up data were collected from 177 patients with a minimum follow-up period of 9 months (mean 54.48 ± 27.84 months). Results In 246 patients, 89.4% experienced immediate postoperative relief of spasm, 91.1% experienced relief at discharge, and 92.7% experienced relief at follow-up. There was no significant difference in outcomes and complications between Group I and Group II (p > 0.05). Preoperatively, patients in Group I had higher rates of facial weakness, tinnitus, tonus, and platysmal involvement as compared with Group II (p < 0.05). The posterior inferior cerebellar artery and vertebral artery were intraoperatively identified as the offending vessels in cases of vasculature compression in a significantly greater number of patients in Group II compared with Group I (p = 0.008 and p = 0.005, respectively, for each vessel). The lateral spread response (LSR) disappeared in 60.48% of the patients in Group I as compared with 74.19% in Group II (p > 0.05). No significant differences in complications were noted between the 2 groups. Conclusions Microvascular decompression is an effective and safe procedure for patients with HFS previously treated using botulinum neurotoxin. Intraoperative monitoring with LSR is an effective tool for evaluating adequate decompression.

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.

scholarly journals A Seven-year Follow-up Study of Patient Satisfaction with Three-implant-retained Mandibular Overdentures

2021 ◽  
Vol 9 (D) ◽  
pp. 103-107
Author(s):  
Hisham Samir ElGabry
Keyword(s):  
Long Term Results ◽  
Complete Dentures ◽  
Patients Satisfaction ◽  
Follow Up Study ◽  
Group I ◽  
Significant Difference ◽  
Male Patients ◽  
Group Ii ◽  
Anterior Mandible

PURPOSE: This study aimed to compare patients’ satisfaction with mandibular overdentures retained by three-splinted implants versus conventional complete denture wearers during a 7-year follow-up study period. MATERIALS AND METHODS: Thirty edentulous male patients (mean age: 60 years) were carefully selected and divided into two equal groups. All patients received a new set of complete dentures. Group I patients received three implants in the anterior mandible and were connected after 3 months with bars, clips, and loaded. Group II patients received conventional complete dentures. Patients’ satisfaction was recorded for both groups at 3 weeks (baseline) and after 1, 3, 5, and 7 years. Patients were then asked to grade their overdentures/dentures on a visual analog scale and written questionnaire to evaluate their overall satisfaction. RESULTS: Satisfaction scores of Group I patients were found to be statistically significantly higher than that of Group II patients (p < 0.05) at 3, 5, and 7 years follow-up, meanwhile, no statistically significant difference was found at baseline or after 12 months. CONCLUSION: The long-term results suggest that three-implant-retained mandibular overdenture with a clip-bar attachment appears to be a successful rehabilitation strategy which is superior to conventional dentures for patients with advanced ridge resorption.

Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression

2007 ◽  
Vol 107 (6) ◽  
pp. 1144-1153 ◽  
Author(s):  
Marc Sindou ◽  
José Leston ◽  
Evelyne Decullier ◽  
François Chapuis
Keyword(s):  
Trigeminal Neuralgia ◽  
Success Rate ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Clear Cut ◽  
Kaplan Meier ◽  
History Of ◽  
Primary Trigeminal Neuralgia

Object The purpose of this study was to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN). Only the cases with a clear-cut neurovascular conflict (vascular contact and/or compression of the root entry zone of the trigeminal nerve) found at surgery and treated with “pure” MVD (decompression of the root without any additional lesioning or cutting of the adjacent rootlets) were retained. Methods The study included 362 patients who were followed up over a period of 1 to 18 years (median follow-up 7.2 years). A Kaplan–Meier survival analysis was generated at 1 and 15 years of follow-up for all of the considered factors. According to Kaplan–Meier analysis, the success rate (defined as pain-free patients without any medication) was 91% at 1 year and estimated to be 73.38% after 15 years of follow-up. Results None of the following patient-related factors played any significant role in prognosis: sex, patient age at surgery, history of systemic hypertension, duration of neuralgia before surgery, or history of failed trigeminal surgery. Patients with atypical neuralgia (a baseline of permanent pain) had the same outcome as those with a typical (purely spasmodic) presentation. In addition, the side and topography of the trigeminal nerve did not play a role, whereas involvement of all three divisions of the nerve had a negative effect on outcome. Concerning anatomical factors, neither the type of the compressive vessel nor its location along or around the root was found to be significant. However, the severity of compression was important—the more severe the degree of compression, the better the outcome (p = 0.002). The authors also found that presence of focal arachnoiditis had a negative influence on outcome (p = 0.002). Conclusions Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly—although not yet reliably—on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate.

scholarly journals Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study

2015 ◽  
Vol 73 (8) ◽  
pp. 660-664 ◽  
Author(s):  
Fabrizio Di Stani ◽  
Christine Ojango ◽  
Demo Dugoni ◽  
Luigi Di Lorenzo ◽  
Salvatore Masala ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
General Health ◽  
Additional Treatment ◽  
Group I ◽  
Classical Trigeminal Neuralgia ◽  
Secondary Endpoints ◽  
Group Ii ◽  
Depression Scales ◽  
Analgesic Block

Classical trigeminal neuralgia (CTN) is treated predominantly by pharmacotherapy but side effects and unsuccessful occurs. The current study was carried out to evaluate the therapeutic effect of combination of pharmacotherapy and lidocaine block. Thirteen patients with CTN managed with pharmacotherapy were recruited and assigned either to no additional treatment (Group I) or to additional analgesic block (Group II). The primary endpoint was the reduction in the frequency of pain episodes in a month assessed at 30 and 90 days. Comparisons of measurements of pain, general health and depression scales were secondary endpoints. The results from the follow-up visits at 30 and 90 days showed the Group II to have larger reduction in the frequency of pain and exhibited a bigger improvement in the scores of the pain, general health and depression scales. The results from this preliminary study suggest a clinical benefit of the combination of pharmacotherapy and lidocaine block.

scholarly journals Microvascular Decompression by Interposition Method for Treatment of Trigeminal Neuralgia Due to Vertebrobasilar Dolichoectasia: A Retrospective Single-Center Study

2021 ◽  
Author(s):  
Feng Yu ◽  
Jia Yin ◽  
Pei-gang Lu ◽  
Zhen-yu Zhao ◽  
Yong-qiang Zhang ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Symptom Duration ◽  
Free Survival ◽  
Kaplan Meier ◽  
Vertebrobasilar Dolichoectasia ◽  
Cerebellar Artery

Abstract Trigeminal neuralgia (TN) due to vertebrobasilar dolichoectasia (VBD) is a rare disease that can be challenging to treat. The objectives of this study are to investigate the characteristics of patients with TN due to VBD and to analyze the efficacy of microvascular decompression (MVD) by the interposition method for treatment of the condition. From 2010 till 2020, the data of 30 patients with TN due to VBD who were treated with MVD by the interposition method were analyzed retrospectively. The characteristics of the patients were compared with those of patients with non-VBD TN (n = 815). Kaplan–Meier survival analysis was performed to determine pain-free survival. The 30 patients (21 males, 9 females; mean age, 63.03 years) accounted for 3.55% of all patients with TN during the study period. In 30 patients, the offending vessel was the basilar artery (BA) in 1 patient, the vertebral artery (VA) in 6 patients, the VA plus the superior cerebellar artery (SCA) in 6 patients, the VA plus the anterior inferior cerebellar artery (AICA) in 12 patients, and the VA+SCA+AICA in 5 patients. Compared to non-VBD TN patients, those with TN due to VBD were significantly more likely to be male, to have TN of the left side, and to have hypertension (all P < 0.001). Mean age at surgery (P = 0.057) and symptom duration (P = 0.308) were comparable between the two groups. All 30 patients had immediate relief of facial pain after MVD and could stop medication. There were no postoperative complications. Over mean follow-up of 76.67 months, 3 patients had recurrence. The mean duration of pain-free survival was 70.77 months. In conclusions, TN due to VBD appears to be more likely in males, in those with hypertension, and to involve the left side. The interposition method performed by experienced and skilled neurosurgeons is a safe and effective treatment for TN due to VBD. Further studies are needed to analyze the associated long-term results and the pain recurrence rate among this special population.

scholarly journals Evaluation of proarrythmogenic effects after different techniques of radiofrequency catheter ablation of atrial fibrillation

2015 ◽  
Vol 17 (1) ◽  
pp. 33 ◽  
Author(s):  
S. N. Artemenko ◽  
A. B. Romanov ◽  
V. V. Shabanov ◽  
I. G. Stenin ◽  
D. A. Yelesin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Linear Lesions ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

To assess proarrythmogenic effects after different techniques of radiofrequency catheter ablation, 427 patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation (AF) were examined. The patients were randomized into four groups: antral pulmonary vein isolation (PVI) (Group I), PVI plus roof line and mitral isthmus ablation (Group II), anatomic ablation of ganglionated plexuses (GP) of the left atrium (Group III) and GP plus PVI (Group IV). At the end of follow up (34,43,2 months) the largest number of proarrythmogenic effects was observed in Group II, 24,8% (26 patients). In the remaining groups the percentage of proarrythmogenic effects did not exceed 11%, neither was there any significant difference among Groups I, III and IV. Thus, the creation of additional linear lesions in the left atrium is a predictor of proarrythmogenic effects during follow up.

scholarly journals Short and Long-Term Follow up Results of Daily 5 Mg Tadalafil as a Treatment for Erectile Dysfunction and Premature Ejaculation

2021 ◽  
Author(s):  
Tarek Gharib ◽  
Ibrahim Abdelal ◽  
Adel Elatreisy ◽  
Elsayed Salih ◽  
Ahmed Sebaey
Keyword(s):  
Erectile Dysfunction ◽  
Premature Ejaculation ◽  
P Value ◽  
Group I ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
The Mean ◽  
Group Ii

Abstract Objective: To evaluate effectiveness and safety of a 5mg tadalafil daily treatment for men with erectile dysfunction (ED) and premature ejaculation (PE) and assessment of long-term follow up by persistence of improvement 2 years after stoppage of tadalafil.Materials and Methods: The study included 160 patients diagnosed with erectile dysfunction from April 2018 to June 2020. All were evaluated using the international index of erectile function questionnaire-5 (IIEF-5) to evaluate ED and intravaginal ejaculatory latency time (IELT) for PE. Patients subdivided into two equal groups. I included 80 patients treated with tadalafil 5 mg daily for 3 months, and group II included 80 patients treated with a placebo for same period. After 3 months treatment and 2 years later after stoppage of tadalafil, all patients were assessed for ED and PE using the same questionnaires. Results: The mean IELT and IIEF pretreatment were 37±11.24 s and 13.2±4.2 respectively for group I, while in group II was 35.98±10.8 s and 13.12±4.11, respectively. After 3 months of treatment, the mean value of IELT in group I showed a highly significant improvement from 37±11.24 sec to 120.5±47.37 sec (p-value < 0.001), but for group II, the mean values of IELT showed no significant improvement from baseline 35.98±10.8 to endpoint 39.43±13.6 ( p-value > 0.05). As regarding the IIEF, there was a highly significant improvement from baseline 13.2±4.2 to endpoint 20.45±4.5 in group I (p-value < 0.001) while there was no significant difference in group II from baseline 13.12±4.11 to endpoint 15±4.84 (p-value > 0.05) . 2 years later after stoppage of tadalafil , 75 patients from group I complete follow up and there was significant improvement in IELT and IIEF form base line (37±11.24) (13.2±4.2) to endpoint (98±18.3) (19.1±2.3) respectively but less than the results after 3 months treatment.ConclusionDaily Tadalafil 5 mg was effective, tolerable, and safe treatment for patients suffering from ED and PE. Long-term follow up after 2 years declared persistence of significant improvement.

scholarly journals Quadriceps- vs. semitendinosus tendon in ACL reconstruction - a prospective study comparing autologous transplants regarding their clinical outcome

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0028
Author(s):  
Katrin Karpinski ◽  
Sebastian Bierke ◽  
Martin Häner ◽  
Tilman Hees ◽  
Wolf Petersen
Keyword(s):  
Clinical Outcome ◽  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Lysholm Score ◽  
Semitendinosus Tendon ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Primary Acl Reconstruction

Aims and Objectives: The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon. Materials and Methods: We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score. Results: The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups. Conclusion: Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.

scholarly journals Efficacy of Low Dose Topiramate and Propranolol in Migraine Prophylaxis

2018 ◽  
Vol 9 (2) ◽  
pp. 49-54
Author(s):  
Muhammad Abdul Momen Khan ◽  
Jannatul Ferdous ◽  
AKM Golam Kabir ◽  
Md Mamnur Rashid ◽  
Md Enayet Ul Islam ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Migraine Prophylaxis ◽  
Drop Out ◽  
Group I ◽  
Significant Difference ◽  
Propranolol Group ◽  
Baseline Information ◽  
Group Ii

Background: Migraine, the second most common cause of headache that can significantly impair the lives of people. Various drugs are available for migraine prophylaxis but all of which have varying degrees of adverse effects that may significantly limit their use.Objectives: To observe whether low dose topiramate is more effective compared to propranolol in migraine prophylaxis.Methods: Total 120 patients the age range of 18 to 50 years were recruited as study population of migraine in the Out Patient Department (OPD) & Headache Clinic,BSMMU.60 patients were administered by Tab.Topiramate 50 mg/ day named as group-I and rest of 60 patients were administered by Tab. Propranolol 80 mg /day named as group-II. Out of them in total 96 patients had completed the study. 47 patients had completed study in group-I and 49 patients in group-II. During trial, three follow up visits were taken for both groups, 1st follow up after 4 weeks of baseline information, 2nd follow up after 4 weeks of treatment, 3rd follow up after 8 weeks of treatment. Efficacy of treatment was measured by frequency, duration and severity of headache as measured by the visual analogue scale (VAS).Results: The mean (SD) age of group-I (topiramate) and group-II (propranolol) group were found 29.72±9.58 years and 30.96±10.11 years respectively. Female sex was found predominant in both groups. At final follow up, there was statistically significant difference in mean (SD) value of frequency of migraine between topiramate and propranolol group (4.72±2.80 vs. 3.48±2.20; p=0.024]. Propranolol appeared statistically significant than topiramate [TPM 5.53±2.98 vs. PRO 4.36±1.55; p=0.047].Regarding severity of headache, better results also were observed in the propranolol group than topiramate (p< 0.05). Both drugs appeared significant in efficacy measurement (p<0.001). Patient drop out was more in the topiramate group than the propranolol group (21.68 % vs. 18.34%). Furthermore, in the topiramate group, patients complained of more adverse effects than propranolol group (23.4% vs. 14.3%), which was statistically significant.Conclusion: The present study suggests that low dose topiramate and propranolol are effective for migraine prophylaxis in reduction of frequency, severity and duration of migraine individually and propranolol appears more effective compared to that of topiramate.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 49-54

Sign in / Sign up

Export Citation Format

Share Document