Long Time Efficacy and Safety of Microvascular Decompression Combined with Internal Neurolysis for Recurrent Trigeminal Neuralgia

Abstract

Objective : To explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD. Methods : Sixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed. Results :The efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18-36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05). Conclusion :A retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of longterm facial numbness and other complications.

Development of a neural network model to establish a surgical paradigm for trigeminal neuralgia patients difficult to classify

“…Alternatively, if there is no vascular compression upon any part of the trigeminus, TN is usually classi ed as [8][9][10], and internal neurolysis (IN) surgery is usually performed with satisfactory treatment e cacy. Internal neurolysis (IN) involves longitudinal incision of the intracranial nerve root to achieve nerve micro destruction and is highly effective at curing ITN and signi cantly reducing the incidence of facial sensory disorders and the degree of numbness [11,12]; therefore, IN has been gradually accepted by an increasing number of scholars [13][14][15]. Our research team also used IN to treat ITN and came to similar conclusions [16].…”

“…Therefore, surgical procedures are often performed without any reference but rather according to the doctor's experience, which may lead to ineffective or unnecessary iatrogenic damage after surgery. In fact, single vascular decompression surgery is usually ineffective, and to avoid the need for a second operation due to ineffective decompression and to improve the success rate of the rst operation, IN surgery alone [13] or combined with vascular decompression [15] is often used in clinical treatment. This is clearly due to a lack of helplessness, and more precise methods need to be further developed.…”

Very early re-do microvascular decompression for patients with trigeminal neuralgia

“…17,18 Also about 90% of patients suffered from facial numbness after MVD combined with internal neurolysis. [19][20][21] Complications could also impact the life quality of the patients. Zhang et al compared the effect and complications of redo MVD and percutaneous radiofrequency thermocoagulation for TN with failed MVD, the result showed that re-do MVD had better pain control and less complication.…”

Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds—scarring, deformation, and the “piston effect”

“…The frequency of hypaesthesia, however, is markedly higher in series from centers which use mechanical intraoperative measures to alter sensory function of the trigeminal nerve either routinely or in patients in whom no clear cause for recurrent TN has been detected [43]. Such measures include "combing" or "pinching" of the trigeminal nerve or "internal neurolysis," as well as "partial transection of the trigeminal nerve," "partial nerve section," or "partial sensory rhizotomy" [1,10,11,17,30,43,49]. Especially when using more extensive sectioning procedures, facial numbness may occur in more than 50% of patients after posterior fossa re-exploration [1,31].…”