Immediate and Long-Term Outcomes of Microvascular Decompression for Mixed Trigeminal Neuralgia

Wu, Adela; Doshi, Tina L.; Hung, Alice L.; Garzón-Muvdi, Tomás; Bender, Matthew T.; Bettegowda, Chetan; Lim, Michael

doi:10.1016/j.wneu.2018.06.016

Cited by 23 publications

(15 citation statements)

References 21 publications

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“…Wu et al reported the long-term efficacy of MVD after a long follow-up of a high number of TN patients, 15 and the results were similar to those of our study. Therefore, internal neurolysis is an effective therapy for TN without vascular compression.…”

Section: Discussionsupporting

confidence: 91%

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

Jiang

Niu

2021

J Neurol Surg A Cent Eur Neurosurg

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Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

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Section: Discussionsupporting

confidence: 91%

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

Jiang

Niu

2021

J Neurol Surg A Cent Eur Neurosurg

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“…The funnel plot of the recurrence rate was symmetric ( Supplementary Figure 2 ), and the results of Egger's test ( t = −1.92, 95% CIs: −0.817 to 0.015, p = 0.059) bolstered this result. Galbraith plots ( Supplementary Figure 3 ) found that the study of Wu et al ( 10 ) had excessive influence on the overall estimate. We adopted sensitivity analysis ( Supplementary Figure 4 ) to evaluate the stability of the results and found that the Wu's study truly had a significant impact on the research results, with the recalculated pooled recurrence rate of 0.094 (0.079–0.110), while leaving the study out.…”

Section: Resultsmentioning

confidence: 99%

“…Numerous original studies have reported the recurrence rate and factors. Throughout the literature, there is marked variability in the reporting of recurrence rates after MVD, ranging from 0 to 26.6% ( 9 , 10 ), mostly due to differences in the sample or center variability. Furthermore, different authors have reported distinct results on the same influencing factors.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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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“…Outcome after microvascular decompression surgery was only slightly worse; recurrence rates were 9.23% in the age group younger than 65 years and 13.33% in the group older than 65 years 19 . However, long-term outcome was determined by concomitant pain as these patients developed TN recurrence in 60.3% following microvascular decompression surgery whereas patients without concomitant pain did not show signs of recurrence in 91.8% within a mean follow-up period of 20.6 months 20 . Depression and anxiety, along with a deterioration in quality of life, are common in patients with TN 21 .…”

Section: Prognostic Factorsmentioning

confidence: 99%

Recent advances in understanding/managing trigeminal neuralgia

Obermann

2019

F1000Res

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Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

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Immediate and Long-Term Outcomes of Microvascular Decompression for Mixed Trigeminal Neuralgia

Cited by 23 publications

References 21 publications

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

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

Recent advances in understanding/managing trigeminal neuralgia

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