Efficacy and Prognostic Value of Partial Sensory Rhizotomy and Microvascular Decompression for Primary Trigeminal Neuralgia: A Comparative Study

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.

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Microvascular Decompression for Idiopathic Primary Trigeminal Neuralgia in Patients Over 75 Years of Age

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000002787 ◽

2016 ◽

Vol 27 (5) ◽

pp. 1295-1297 ◽

Cited By ~ 11

Author(s):

Hua Zhao ◽

Yinda Tang ◽

Xin Zhang ◽

Shiting Li

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Primary Trigeminal Neuralgia

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Recurrence Rates After Microvascular Decompression in Patients With Primary Trigeminal Neuralgia and Its Influencing Factors: A Systematic Review and Meta-Analysis Based on 8,172 Surgery Patients

Frontiers in Neurology ◽

10.3389/fneur.2021.738032 ◽

2021 ◽

Vol 12 ◽

Author(s):

Fangyu Chen ◽

Yuming Niu ◽

Fan Meng ◽

Pan Xu ◽

Chao Zhang ◽

...

Keyword(s):

Systematic Review ◽

Trigeminal Neuralgia ◽

Recurrence Rate ◽

Influencing Factors ◽

Microvascular Decompression ◽

Meta Analysis ◽

Postoperative Recurrence ◽

Recurrence Rates ◽

Primary Trigeminal Neuralgia

Background: Primary trigeminal neuralgia (PTN) is known to reoccur following microvascular decompression (MVD) surgery. However, the rates and contributing factors related to PTN recurrence remain controversial. The purpose of this study was to explore the postoperative recurrence rates and related influencing factors of patients with PTN after MVD. Additionally, recurrence rates after different treatments were compared to provide guidelines for clinicians.Methods: We conducted systematic reviews and meta-analyses in accordance with the preferred reporting items of the PRISMA guidelines. We searched nine databases, namely, the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CBM, CNKI, VIP, and Wanfang databases, from establishment to July 13, 2020, selecting for studies about the long-term postoperative efficacy of MVD in the treatment of PTN. Factors associated with higher recurrence rates after MVD and long-term postoperative results of other treatments underwent formal meta-analysis, where odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated. The dose-response model was used to inspect the associations between several factors and higher recurrence rates.Results: Seventy-four studies (8,172 patients, 32 case series studies, and 42 non-randomized controlled trials) were analyzed in our research. Overall, 956 out of 8,172 patients relapsed, and the pooled recurrence rate was 0.096 (0.080–0.113). Influencing factors of relatively higher recurrence rates included atypical trigeminal neuralgia symptoms, lack of nerve groove, non-arterial compression, patients who were 50–60 years old, and longer disease duration. Dose–response analysis showed that the recurrence rate had a significant trend with the published year and the follow-up time. Simultaneously, the recurrence rate of MVD treatment was much lower than that of conventional drug treatment, gamma knife surgery, percutaneous balloon compression, and radiofrequency thermocoagulation. When the surgical technique was improved or combined with partial sensory rhizotomy (PSR), the postoperative recurrence rates were significantly reduced.Conclusions: Even for PTN patients who have a successful operation, ~10% of them will still relapse. This research identifies several factors that can affect the recurrence rate. Compared with other operations, MVD has a relatively lower recurrence rate. Our analysis suggests that improved surgical techniques and combining PSR and MVD will yield better results.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020159276.

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Predicting the Outcome of Microvascular Decompression for Primary Trigeminal Neuralgia by the Use of Magnetic Resonance Tomographic Angiography

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3182801b64 ◽

2013 ◽

Vol 24 (5) ◽

pp. 1699-1702 ◽

Cited By ~ 7

Author(s):

Ying Chai ◽

Minjie Chen ◽

Weijie Zhang ◽

Wenhao Zhang

Keyword(s):

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Tomographic Angiography ◽

Primary Trigeminal Neuralgia ◽

Magnetic Resonance Tomographic Angiography

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Utility of Brainstem Trigeminal Evoked Potentials in Patients With Primary Trigeminal Neuralgia Treated by Microvascular Decompression

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000003882 ◽

2017 ◽

Vol 28 (6) ◽

pp. e571-e577 ◽

Cited By ~ 4

Author(s):

Jin Zhu ◽

Xin Zhang ◽

Hua Zhao ◽

Yin-Da Tang ◽

Ting-Ting Ying ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Evoked Potentials ◽

Microvascular Decompression ◽

Primary Trigeminal Neuralgia

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Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1692683 ◽

2019 ◽

Vol 81 (05) ◽

pp. 567-571

Author(s):

Zhenyu Huang ◽

Benfang Pu ◽

Fusheng Li ◽

KaiZhang Liu ◽

Chunhui Hua ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Symptom Relief ◽

Superior Cerebellar Artery ◽

Complete Relief ◽

Cerebellar Artery ◽

Definitive Therapy ◽

Primary Trigeminal Neuralgia ◽

Early Reoperation

Background Microvascular decompression (MVD) has been widely accepted as a definitive therapy for primary trigeminal neuralgia (TN). However, some patients may not experience relief of TN symptoms following surgery. In this study, the findings of redo MVD are discussed.Methods Between 2015 and 2017, 205 patients with primary TN underwent MVD surgery in Shanghai Tongren Hospital. Among these patients, 187 had immediate complete relief of symptoms, 8 improved apparently, and 10 reported no symptom relief. Of the 10 patients without relief, 6 underwent reoperation within 5 days, 2 underwent reoperation 3 months after the first procedure, and 2 refused to undergo reoperation.Results The symptoms of those patients who received reoperation disappeared immediately after the surgery. In the second operations, new conflict sites at the motor roots were found in five cases. The real offending vessels were the superior cerebellar artery (SCA) or branch of the SCA in seven cases and the petrosal vein in one case. The nerve was not decompressed completely in either of the two cases. At the 12-month follow-up, no recurrence was found. For the other two patients who did not have reoperation, their symptom persisted. Postoperative complications showed no significant differences between the first and second operations.Conclusion Compression of the motor roots might be one of the causes of TN. Thorough exploration of both sensory and motor roots of the trigeminal nerve is essential to performing a successful MVD operation. Early reoperation for resistant TN after MVD does not increase the incidence of complications.

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