Development and Evaluation of a Preoperative Trigeminal Neuralgia Scoring System to Predict Long-Term Outcome Following Microvascular Decompression

Panczykowski, David M.; Jani, Ronak H.; Hughes, Marion A.; Sekula, Raymond F.

doi:10.1093/neuros/nyz376

Cited by 41 publications

(34 citation statements)

References 31 publications

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“…Until now, the carbamazepine was still the preferred drug for TN patients, which provides pain relief in 70% of patients. Previous study showed that response to carbamazepine positively remains signi cant for prognosis of TN following MVD [22]. In our study, we found parallel results that response to carbamazepine positively signi cantly predicted satisfying outcome following PBC.…”

Section: Discussionsupporting

confidence: 86%

“…Several previous studies showed clinical factors such as symptom duration, preoperative NRS, previous surgery, TN type and compression severity score of TN nerve may in uence the curative effect. Previous studies showed that atypical pain was associated with a poorer prognosis not only in ablative procedures such as GR and SRS, but also in non-ablative procedures such as MVD [22,12]. Tyler-Kabara et al showed that 74% of patients with typical pain had excellent outcomes following MVD, compared with only 35% of patients with atypical pain [26].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that vascular contact with the trigeminal nerve is universal (occurring in 82 to 92%) [15]. Nevertheless, several papers showed that neurovascular compression on MRI remains important for predicting postoperative outcome following MVD [22,29]. A meta-analysis showed that artery compression to be an independent predictor of pain relief following MVD (OR 3.35, 95% CI 1.91-5.88) [14].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Liu

Tang

et al. 2021

Neurosurg Rev

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Because of its convenience and safety, percutaneous balloon compression (PBC) has become a more popular remedy for trigeminal neuralgia (TN) recently. The objective of this study was to establish a nomogram that can be used to preoperatively prognosticate the likelihood of pain-free based on preoperative disease characteristics. Clinical data were collected from those TN cases who had undergone PBC during the period of 2015 and 2020 in Qingdao municipal hospital. We excluded the cases caused by space-occupying lesion or had undergone MVD, Percutaneous glycerol rhizotomy (PGR) and glycerol rhizotomy (GR). A nomogram was established based on the results of multivariable logistic analysis. A receiver operating characteristic curve (ROC) analysis was applied to evaluate the reliability of models. The plotted decision curves were also used to assess the net bene t of nomogram-assisted decisions. Internal validation was performed using the ROC by bootstrap sampling. Finally, 16 cases and 69 cases were included into the ineffective and effective groups respectively. In the crude, adjust I and adjust II models, response to carbamazepine positively, the grade II or III compression severity score and classical TN type were all considered to be signi cant predictors of pain relief (BNI grades I-III) at 3 months follow-up. The AUC, accuracy, speci city, and sensitivity of the nomogram system was 0.83, 0.85, 0.75, 0.87 respectively for predicting patient outcomes. The decision curves showed good performance for the nomogram system in terms of clinical application. While, more research with validation in multiple, external independent patient populations is needed.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Liu

Tang

et al. 2021

Neurosurg Rev

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“…However, the reporting period of this study started before the availability of high-resolution MRI with gradient echo sequences, which has a higher sensitivity for detecting NVC pre-operatively. Some previous studies have proposed that the severity of NVC is important in determining the success of MVD [17,37], although others have not [52].…”

Section: Discussionmentioning

confidence: 99%

Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors

et al. 2021

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Objective Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD) and percutaneous procedures (glycerol rhizolysis; thermocoagulation; and balloon compression). Although the efficacy of each procedure has been documented, direct comparisons of their relative efficacies for TN are lacking. We aimed to directly compare long-term outcomes after first-time MVD with percutaneous surgery in primary (idiopathic and classical) TN and identify predictors of outcome. Methods We conducted a retrospective analysis of prospectively collected data on 185 patients undergoing MVD and 129 undergoing percutaneous surgery. Procedures were performed by one of two neurosurgeons in a single centre; an independent observer collected long-term follow-up data by interviews, using the same outcome measures for all procedures. Results MVD patients were younger than those undergoing percutaneous surgery (P <.001). MVD provided superior initial pain relief (P <.001): 87.0% had Barrow Neurological Institute class I or II pain scores after MVD compared with 67.2% after percutaneous surgery. The complication rate for percutaneous procedures was 35.7% and for MVDs was 24.9% (P =.04), including minor and transient complications. Kaplan-Meier analysis demonstrated that MVD provided longer pain relief than percutaneous procedures (P <.001); 25% of patients had recurrence at 96 months following MVD compared with 12 months after percutaneous surgery. Subgroup analysis showed that balloon compression provided more durable relief amongst percutaneous procedures. Multivariate analysis revealed that post-operative numbness and age were prognostic factors for percutaneous procedures (P =.03 and .01, respectively). Conclusions MVD provides better initial pain relief and longer durability of relief than percutaneous surgery, although carrying a small risk of major complications. Amongst percutaneous procedures, balloon compression gave the most durable relief from pain. Older age and post-operative numbness were predictors of good outcome from percutaneous surgery. These results can help clinicians to counsel patients with primary TN on neurosurgical treatment selection for pain relief.

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“…These are favorable factors for pain resolution after microvascular decompression. [ 10 ] For patients with these pain characteristics, the presence of some organic etiology should be rigorously investigated on multiple plane MR imaging.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia caused by an arachnoid cyst in Meckel’s cave: A case report and literature review

Hanakita

Oya

Matsui

2021

Surgical Neurology International

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Background: We present a rare case of trigeminal neuralgia (TN) caused by an arachnoid cyst (AC) in Meckel’s cave (MC). Case Description: A 35-year-old man presented with facial pain in the left maxillary and mandibular regions. Since the initial magnetic resonance (MR) imaging showed no apparent offending vessels or tumors, the patient was diagnosed with idiopathic TN, for which carbamazepine was initially effective. When his pain worsened, he was referred to our hospital. A slightly asymmetric shape of MC and distorted course of the trigeminal nerve was confirmed on the initial and repeat MR images. His pain was characterized as electric-shock-like pain, which was triggered by touching the face. Under the tentative diagnosis of an AC confined to MC compressing the trigeminal nerve, the exploration of MC through suboccipital craniotomy was performed. Intraoperatively, the AC was identified in the rostral portion of MC. The indentation of the trigeminal nerve was also observed at the orifice of MC, indicating severe compression by the AC. The wall of the AC was fenestrated. The patient’s pain was relieved immediately after surgery. Postoperative MR images showed that the course of the trigeminal nerve was straightened. Although our literature review found five similar cases, the size of the AC was the smallest in our case. Conclusion: Although it is rare, the AC confined to MC can cause TN. The findings of this study emphasize the importance of evaluating subtle radiological findings of compression on the trigeminal nerve in cases of TN seemingly without neurovascular compression.

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Development and Evaluation of a Preoperative Trigeminal Neuralgia Scoring System to Predict Long-Term Outcome Following Microvascular Decompression

Cited by 41 publications

References 31 publications

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Prognostic nomogram for percutaneous balloon compression in the treatment of trigeminal neuralgia

Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors

Trigeminal neuralgia caused by an arachnoid cyst in Meckel’s cave: A case report and literature review

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