Microvascular Decompression for Classic Trigeminal Neuralgia

Neurosurgery ◽  
2013 ◽  
Vol 72 (5) ◽  
pp. 749-754 ◽  
Author(s):  
Vishruth K. Reddy ◽  
Scott L. Parker ◽  
Samit A. Patrawala ◽  
Dennis T. Lockney ◽  
Pei-Fang Su ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Treatment Effectiveness ◽  
Characteristic Curve ◽  
Minimum Clinically Important Difference ◽  
Pain Scale ◽  
Critical Threshold ◽  
Point Estimate ◽  
Patient Reported ◽  
Preoperative Expectations

Abstract BACKGROUND: Outcomes studies use patient-reported outcome (PRO) measurements to assess treatment effectiveness, but can lack direct clinical meaning. Minimum clinically important difference (MCID) calculation provides a point estimate of the critical threshold needed to achieve clinically relevant treatment effectiveness. MCID remains uninvestigated for microvascular decompression (MVD), a common surgical procedure for trigeminal neuralgia. OBJECTIVE: We aimed to determine MCID for the most commonly used PRO measures of pain after MVD: Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Scale (BNI-PS). METHODS: Sixty consecutive patients with classic trigeminal neuralgia who decided to undergo MVD by a single surgeon were prospectively assessed with VAS and BNI-PS preoperatively and 2 years postoperatively. Three anchors were used to assign each patient's outcome. We then used 3 well-established, anchor-based methods to calculate MCID. RESULTS: Patients experienced significant improvement in both VAS (9.9 vs 2.0, P < .001) and BNI-PS (5.0 vs 1.9, P < .001) after MVD. The area under the receiver-operating characteristic curve was greater for BNI-PS than for VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS: 1.40-8.87, BNI-PS: 0.95-3.26). CONCLUSION: MVD-specific MCID is highly variable based on calculation technique. Some of these calculations appear to either overestimate or underestimate the patients' preoperative expectations. When the different MCID methods are averaged, the results are clinically appropriate and consistent with preoperative expectations. The average MCID for VAS is 6.25 and for BNI-PS is 2.44.

scholarly journals Percutaneous Stereotactic Radiofrequency Lesioning for Trigeminal Neuralgia

Neurosurgery ◽  
2013 ◽  
Vol 74 (3) ◽  
pp. 262-266 ◽  
Author(s):  
Vishruth K. Reddy ◽  
Scott L. Parker ◽  
Dennis T. Lockney ◽  
Samit A. Patrawala ◽  
Pei-Fang Su ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Effectiveness ◽  
Characteristic Curve ◽  
Minimum Clinically Important Difference ◽  
Health Transition ◽  
Detectable Change ◽  
Minimum Detectable Change ◽  
Clinically Important Difference ◽  
Patient Reported ◽  
Transition Index

Abstract BACKGROUND: The Visual Analog Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNI-PS) are 2 patient-reported outcome (PRO) tools frequently used to rate pain from trigeminal neuralgia (TN). Outcomes studies often use these patient-reported outcomes to assess treatment effectiveness, but it is unknown exactly what degree of change in the numerical scores constitutes the minimum clinically important difference (MCID). MCID remains uninvestigated for percutaneous stereotactic radiofrequency lesioning (RFL), a common surgical procedure for TN. OBJECTIVE: To determine MCID values for the VAS and BNI-PS in patients undergoing RFL. METHODS: Forty-three consecutive patients with TN who underwent RFL by a single surgeon were prospectively assessed with the VAS and BNI-PS preoperatively and 3 years postoperatively. Three anchors were used to assign each patient's outcome: satisfaction, willingness to have the surgery again, and Health Transition Index. We then used 3 well-established, anchor-based methods to calculate MCID: average change, minimum detectable change, and change difference. RESULTS: Patients experienced substantial improvement in both VAS (9.81 vs 3.35; P < .001) and BNI-PS (4.95 vs 2.44; P < .001) after RFL. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS, 4.13-8.20; BNI-PS, 1.03-3.30). The area under the receiver-operating characteristic curve was greater for BNI-PS compared with VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID. CONCLUSION: RFL-specific MCID is variable on the basis of the calculation technique. With the use of the minimum detectable change calculation method with the Health Transition Index anchor, the minimum clinically important difference is 4.49 for VAS and 1.16 for BNI-PS after RFL for TN.

175. Discrepancy in patient-reported pain using the numeric pain scale and a percentage change to quantify treatment effectiveness after pain injections

2020 ◽  
Vol 20 (9) ◽  
pp. S86-S87
Author(s):  
Barthelemy Liabaud ◽  
Puneet Ralhan ◽  
Sirish Khanal ◽  
Andrew Beaufort ◽  
Joshua D. Lavian ◽  
...  
Keyword(s):  
Treatment Effectiveness ◽  
Pain Scale ◽  
Percentage Change ◽  
Patient Reported ◽  
Numeric Pain Scale

scholarly journals The Durability of Pain Relief Following Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Alexandra D Baker ◽  
Melvin Field
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Microvascular Decompression ◽  
Retrospective Chart Review ◽  
Postoperative Recurrence ◽  
Pain Scale ◽  
Neurovascular Compression ◽  
Recurrence Rates

Abstract INTRODUCTION Trigeminal neuralgia (TGN) is a facial pain disorder that is paroxysmal, stabbing, and produces a shooting pain that affects the face due to the compression of the trigeminal nerve. Literature has suggested that the use of an endoscope for microvascular decompression (eMVD), as opposed to a microscope alone, is more likely to identify the source of neurovascular compression and ensure that the nerve is adequately decompressed. However, the recurrence of TGN pain continues to be an issue for patients. This project will assess the long-term success of eMVD using the reduction in Barrow Pain Scale score and recurrence rate at 1 yr. METHODS This retrospective chart review aims at exploring the efficacy of eMVD for TGN by studying rates of recurrence in a cohort of 300 patients and comparing them to the literature using descriptive statistics. This is the largest study to date evaluating postoperative recurrence for eMVD for TGN. RESULTS In this cohort, on average, patients reduced their pain scale by 2.99 units on the Barrow Pain Scale. Additionally, 95.5% of patients experienced an immediate pain relief after eMVD surgery, while only 4.3% had no improvement in TGN pain after the procedure. In this eMVD patient cohort, 22% of patients had partial recurrence of TGN pain. CONCLUSION The endoscope seems to provide long-term success for eliminating TGN pain and is at least as successful as traditional MVD. Over 95% of patients with follow-up data experienced an immediate pain relief, indicating that the efficacy of this procedure is excellent. Recurrence rates of TGN pain seem to be comparable to the existing literature on traditional MVD approaches. This cohort had a partial recurrence rate of 22%, while previous MVD studies have shown significant recurrence rates between 3% and 32%. This indicates that significant recurrence rates of TGN need to be further investigated.

scholarly journals Decreased Probability of Initial Pain Cessation in Classic Trigeminal Neuralgia Treated With Gamma Knife Surgery in Case of Previous Microvascular Decompression

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 87-95 ◽  
Author(s):  
Constantin Tuleasca ◽  
Romain Carron ◽  
Noémie Resseguier ◽  
Anne Donnet ◽  
Philippe Roussel ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Lower Probability ◽  
Patient Reported ◽  
History Of ◽  
Global Population

Abstract BACKGROUND: Microvascular decompression (MVD) is the reference technique for pharmacoresistant trigeminal neuralgia (TN). OBJECTIVE: To establish whether the safety and efficacy of Gamma Knife surgery for recurrent TN are influenced by prior MVD. METHODS: Between July 1992 and November 2010, 54 of 737 patients (45 of 497 with >1 year of follow-up) had a history of MVD (approximately half also with previous ablative procedure) and were operated on with Gamma Knife surgery for TN in the Timone University Hospital. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range, 3.9–11.9 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range, 70–90 Gy) was delivered. RESULTS: The median follow-up time was 39.5 months (range, 14.1–144.6 months). Thirty-five patients (77.8%) were initially pain free in a median time of 14 days (range, 0–180 days), much lower compared with our global population of classic TN (P = .01). Their actuarial probabilities of remaining pain-free without medication at 3, 5, 7, and 10 years were 66.5%, 59.1%, 59.1%, and 44.3%. The hypoesthesia actuarial rate at 1 year was 9.1% and remained stable until 12 years (median, 8 months). CONCLUSION: Patients with previous MVD showed a significantly lower probability of initial pain cessation compared with our global population with classic TN (P = .01). The toxicity was low (only 9.1% hypoesthesia); furthermore, no patient reported bothersome hypoesthesia. However, the probability of maintaining pain relief without medication was 44.3% at 10 years, similar to our global series of classic TN (P = .85).

A Novel Technical Refinement of Microvascular Decompression: Pain Relief and Complication Rate in a Consecutive Series of Patients With Trigeminal Neuralgia

2020 ◽  
Vol 19 (3) ◽  
pp. 226-233 ◽  
Author(s):  
Francesco Tomasello ◽  
Antonino Germanò ◽  
Angelo Lavano ◽  
Alberto Romano ◽  
Daniele Cafarella ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Complication Rate ◽  
Csf Leak ◽  
Complication Rates ◽  
Patient Reported ◽  
Facial Numbness

Abstract BACKGROUND Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. We recently proposed some technical nuances for complication avoidance related to MVD. OBJECTIVE To verify the efficacy of the proposed refinement of the standard MVD technique in terms of resolution of the pain and reduction of complication rates. METHODS We analyzed surgical and outcome data of patients with TN using a novel surgical refinement to MVD, over the last 4 yr. Outcome variables included pain relief, facial numbness, muscular atrophy, local cutaneous occipital and temporal pain or numbness, cerebellar injury, hearing loss, cranial nerve deficits, wound infection, and cerebrospinal fluid (CSF) leak. Overall complication rate was defined as the occurrence of any of the aforementioned items. RESULTS A total of 72 consecutive patients were enrolled in the study. Pain relief was achieved in 91.6% and 88.8% of patients at 1- and 4-yr follow-up, respectively. No patient reported postoperative facial numbness during the entire follow-up period. The incidence of CSF leak was 1.4%. One patient developed a complete hearing loss and another a minor cerebellar ischemia. There was no mortality. The overall complication rate was 5.6%, but only 1.4% of patients experienced permanent sequelae. CONCLUSION The proposed refinement of the standard MVD technique has proved effective in maintaining excellent results in terms of pain relief while minimizing the overall complication rate associated with this surgical approach.

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