A Systematic Review of Repeat Microvascular Decompression for Recurrent or Persistent Trigeminal Neuralgia

Jiao, Liwu; Hao, Yue; Lv, Jibo; Xie, Yong; Sun, Wei; Ding, Guolin; Cui, Simin

doi:10.1016/j.wneu.2021.11.129

Cited by 17 publications

(14 citation statements)

References 27 publications

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“…Moreover, postoperative complications following repeat surgery has been reported at 37% and includes facial numbness, hearing loss, infection, and CSF leak. 15 The high rates of reoperation surgery and associated complications emphasize the importance of identifying these high-risk patient populations for preoperative optimization or alternative treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

Dincer,

Tabor,

Pappajohn

et al. 2024

J Neurol Surg B Skull Base

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Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS. Patient data from 2015-2020 were obtained from the ACS-NSQIP database and were included in this study if they had a procedure corresponding to a microvascular decompression with the current procedural terminology (CPT) code 61458. Patient demographics, comorbidities, and outcomes were analyzed. The overall rate of reoperation in the cohort is 3.2% and 7.2% for patients with morbid obesity (BMI > 40) (p=0.006). Patients with morbid obesity were more likely to have comorbidities such as hypertension (60.9 vs. 33.5%; p<0.0001) and diabetes (16.3 vs. 7.7%; p=0.0002), and increased procedure duration (179 vs. 164 minutes; p=0.02). Indications for reoperation include CSF leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation. We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reo

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Section: Discussionmentioning

confidence: 99%

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

Dincer,

Tabor,

Pappajohn

et al. 2024

J Neurol Surg B Skull Base

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“…The results showed that patients with MVD had good long-term pain control rates. The recurrence rate was ~14–16% ( 26 , 38 , 39 ). Moreover, the recurrence rate decreased over time ( 32 ).…”

Section: Recurrence and Complicationsmentioning

confidence: 99%

“…Data on the preferred treatment of patients with recurrent TN are limited. Fossa posterior re-exploration (redo MVD) is an effective treatment measure for recurrent TN after failed MVD ( 39 , 42 , 43 ); however, studies have found that re-MVD is more effective in patients with residual responsible vessels ( 44 , 45 ). If no vascular compression is found during re-exploration, partial sensory rhizotomy, internal neurolysis, or trigeminal nerve combing can be used ( 40 , 42 ).…”

Section: Recurrence and Complicationsmentioning

confidence: 99%

Microvascular decompression: Diversified of imaging uses, advantages of treating trigeminal neuralgia and improvement after the application of endoscopic technology

Leng²,

Xia³

et al. 2022

Front. Neurol.

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Classical trigeminal neuralgia (CTN) is a unilateral and severe facial pain disease, which seriously affects the patient's quality of life. Microvascular decompression (MVD) is currently the most effective surgical method, and it is the only treatment for the etiology of CTN. Imaging for MVD has been increasingly used, and the advantages and disadvantages of endoscopy-assisted vascular decompression surgery have been controversially debated. In this review, we aimed to discuss the advantages of MVD in the treatment of patients with CTN, the importance of using imaging in disease management, and the improvements of vascular decompression surgery through the application and maturity of endoscopic techniques. Compared with other surgical methods, MVD has more prominent short- and long-term treatment effects. Its selection depends on the accurate discovery of neurovascular compression by preoperative imaging. Moreover, magnetic resonance imaging plays a diverse role in MVD, not only in identifying the responsible vessels but also in determining the prognosis and as a tool for scientific research. The use of endoscopic techniques provides improved visualization of the MVD and additional benefits for vascular decompression surgery.

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“…By synchronizing with the primary operator, an assistant with extensive endoscopic experience should perform EMVD procedures. The assistant's presence can significantly reduce the length of the operation [13,33,34] .…”

Section: Farid and Elkheshinmentioning

confidence: 99%

Evaluation of Endoscopic Microvascular Decompression for Trigeminal Neuralgia

Atiah

Ayad

Rabea

2022

International Journal of Medical Arts

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Article informationBackground: A severe, intermittent pain in the trigeminal nerve distribution area on one side of the face is known as trigeminal neuralgia. The primary pathophysiological cause of trigeminal neuralgia is neurovascular compression, which results in demyelination of the trigeminal nerve root in the cerebellopontine angle area. Endoscopes offer 360-degree views and bright lighting, making it much easier to spot and treat vascular conflicts than with conventional techniques. The Aim of the work:To evaluate the effectiveness of endoscopic microvascular decompression in patients with primary trigeminal neuralgia regarding pain control, recurrence rate and procedure-related complications. Patients and methods:The current study was applied on 12 patients with 1ry trigeminal neuralgia whom afforded to endoscopic micro-vascular decompression with mean age 59.1±9.54 years. All were submitted to clinical assessment through full history, clinical neurological examination, laboratory and imaging studies. The outcome was assessed by different scales, like visual analogue scale [VAS], pain intensity score of Barrow Neurological Institute [BNI], general and facial function scores. The follow up visits were scheduled directly after surgery, and at 3 and 6 months postoperatively. Results: The commonest affected vessel in the present study was superior cerebellar artery [SCA] [41.75%] then anterior inferior cerebellar artery [AICA] [16.7%]. Majority of patients use carbamazepine [66.7%], followed by gabapentin [58.3%]; 33% of the patients were on monotherapy and 66.7% were on combined therapy. There was significant progressive improvement of pain, general and facial function directly after surgery and till the end of follow up duration. The most common reported complication was transient unsteadiness [16.7%], with recurrence rate of 8.3% after 6 months. Conclusion: Endoscopic microvascular decompression for trigeminal neuralgia can have a promising result as regard relieving of pain with subsequent improvement of general and facial function scores with low frequency of complications and recurrence.

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A Systematic Review of Repeat Microvascular Decompression for Recurrent or Persistent Trigeminal Neuralgia

Cited by 17 publications

References 27 publications

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

Microvascular decompression: Diversified of imaging uses, advantages of treating trigeminal neuralgia and improvement after the application of endoscopic technology

Evaluation of Endoscopic Microvascular Decompression for Trigeminal Neuralgia

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