Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia

Background: Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, respectively, p = 0.03). The median follow-up was 61.1 months for the MVD group and 56.8 months for the GKRS group. The favorable outcomes [Barrow Neurological Institute (BNI) pain score, BNI scores I–II] occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (p = 0.009). The favorable outcomes in the percentage of patients after MVD 1, 3, 5, and 7 years were 95.7, 85.1, 74.2, and 74.2%, respectively, whereas the corresponding percentages after GKRS were 76.5, 66.2, 56.6, and 47.2%, respectively (p = 0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (p = 0.036), but the incidence of new and worsening facial numbness was lower in the GKRS group (p < 0.001).Conclusions: MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient's unique condition and wishes.

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Comparison of microvascular decompression and two isocenters gamma knife for the treatment of trigeminal neuralgia caused by vertebrobasilar compression

10.21203/rs.3.rs-407050/v1 ◽

2021 ◽

Author(s):

Zhen Zhao ◽

Songshan Chai ◽

Jiajing Wang ◽

Xiaobing Jiang ◽

Chuansheng Nie ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Gamma Knife ◽

Microvascular Decompression ◽

Gamma Knife Radiosurgery ◽

Therapeutic Effects ◽

Imaging Data ◽

Vertebrobasilar Dolichoectasia ◽

Surgical Methods ◽

Union Hospital ◽

Facial Numbness

Abstract Objective: Vertebrobasilar dolichoectasia (VBD) is one of the uncommon causes of trigeminal neuralgia (TN). The main surgical treatments for TN caused by VBD (VBD-TN) are invasive microvascular decompression (MVD) and mini-invasive Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically reported, so this study evaluated the outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study of patients diagnosed with VBD-TN in Wuhan Union Hospital was performed from March 2011 to March 2019. A total of 80 patients were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. Among patients in the GKRS group, all performed by two isocenters gamma knife. The imaging data, intraoperative findings, outcomes, and complications of the two groups were analyzed and compared.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, p=0.03). The average follow-up was 61.1 months for the MVD group and was 56.8 months for the GKRS group. The favorable outcomes (BNI score I-II) occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (P=0.009). The favorable outcomes in the percentage of patients after MVD 1,3,5 and 7 years were 95.7%, 85.1%, 74.2%, and 74.2%. The corresponding percentages after GKRS were 76.5%, 66.2%, 56.6% and 47.2%, respectively (P=0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (P=0.036), but the incidence of new and worsening facial numbness was higher in the GKRS group (P<0.001).Conclusions: For VBD-TN, MVD is superior to GKRS in obtaining and maintaining favorable outcomes, but it also comes with more complications other than facial sensation. Treatment choice can be tailored to a patient’s unique condition and wishes.

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Gamma Knife radiosurgery for bilateral trigeminal neuralgia

Journal of Neurosurgery ◽

10.3171/2018.6.jns172646 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1591-1598

Author(s):

Corbin A. Helis ◽

Emory McTyre ◽

Michael T. Munley ◽

J. Daniel Bourland ◽

John T. Lucas ◽

...

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Treatment Outcomes ◽

Gamma Knife ◽

Median Duration ◽

Gamma Knife Radiosurgery ◽

Persistent Symptoms ◽

Significant Difference ◽

Facial Numbness

OBJECTIVEA small subset of patients with trigeminal neuralgia (TN) will experience bilateral symptoms. Treatment in these patients is controversial because the population is heterogeneous and patients may have nonvascular etiologies of their pain. This study reports treatment outcomes in the largest cohort of patients with bilateral TN who have undergone Gamma Knife radiosurgery (GKRS) to date.METHODSA retrospective chart review identified 51 individual nerves in 34 patients with bilateral TN who were treated with GKRS at the authors’ institution between 2001 and 2015, with 12 nerves in 11 patients undergoing repeat GKRS for recurrent or persistent symptoms. Long-term follow-up was obtained by telephone interview. Pain outcomes were measured using the Barrow Neurological Institute (BNI) pain scale, with BNI IIIb or better considered a successful treatment.RESULTSThere was sufficient follow-up to determine treatment outcomes for 48 individual nerves in 33 patients. Of these nerves, 42 (88%) achieved at least BNI IIIb pain relief. The median duration of pain relief was 1.9 years, and 1-, 3-, and 5-year pain relief rates were 64%, 44%, and 44%, respectively. No patients experienced bothersome facial numbness, and 1 case of anesthesia dolorosa and 2 cases of corneal dryness were reported. Patients with a history of definite or possible multiple sclerosis were significantly more likely to experience BNI IV–V relapse. There was no statistically significant difference in treatment outcomes between patients in this series versus a large cohort of patients with unilateral TN treated at the authors’ institution. There was sufficient follow-up to determine treatment outcomes for 11 individual nerves in 10 patients treated with repeat GKRS. Ten nerves (91%) improved to at least BNI IIIb after treatment. The median duration of pain relief was 2.8 years, with 1-, 3-, and 5-year rates of pain relief of 79%, 53%, and 53%, respectively. There was no statistically significant difference in outcomes between initial and repeat GKRS. One case of bothersome facial numbness and 1 case of corneal dryness were reported, with no patients developing anesthesia dolorosa with retreatment.CONCLUSIONSGKRS is a safe, well-tolerated treatment for patients with medically refractory bilateral TN. Efficacy of treatment appears similar to that in patients with unilateral TN. GKRS can be safely repeated in this population if necessary.

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