Microvascular Decompression and Percutaneous Rhizotomy in Trigeminal Neuralgia

Abstract

We analyzed 417 patients with trigeminal neuralgia who underwent microvascular decompression (MVD; n = 146) or percutaneous procedures, i.e. radio-frequency rhizotomy (RFR; n = 235) and glycerol rhizotomy (GR; n = 36) between March 1973 and December 1996. MVD and RFR showed the highest rates of initial pain relief (MVD 96.5%; RFR 92.3%; GR 82.8%). RFR and GR had 5.1 and 3.3% rates of facial dysesthesia, respectively, and MVD had the lowest rate (0.3%). Among 9 cases (8.6%) with recurrences after MVD, 8 cases underwent RFR and all of them obtained good long-term results (7.2 years on average). We concluded that MVD is the treatment of choice for tolerant younger patients and should be recommended for patients who desire no sensory deficit. We also determined that radiofrequency rhizotomy is the procedure of choice for patients in whom MVD failed.

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

“…At least 2 patients in their series had no vascular compression and had pain recurrence. 27 Chen and Lee reviewed 114 cases in which patients had undergone MVD with at least 2 years' follow-up and found a recurrence rate of 17.5%. They noted that 4 patients did not have any visible compression at the time of surgery, and 9 patients had a prominent bone spur or acute angulation at the entry into Meckel's cave as the proposed cause of compression.…”

“…A review of the literature reveals a wide range of recurrence rates of approximately 6%-41%. 5,6,8,10,11,22,23,25,[27][28][29]33,[36][37][38][39][41][42][43][44] Surgical alternatives after recurrence include repeat exploration for recurrent vascular compression and microvascular decompression (MVD), internal neurolysis, or radiofrequency lesioning. Other alternatives for recurrent TN include partial or complete sensory rhizotomy, balloon rhizotomy, glycerol injections, and radiosurgery.…”

Cost-effectiveness analysis for trigeminal neuralgia: Cyberknife vs microvascular decompression

“…Stereotactic radio surgery has become an important treatment alternative to surgery for a variety of intracranial diseases (Andrews et al 2006). In TN disease, MVD surgery is still considered the first line treatment for medical unresponsive TN (Fujimaki et al 1990;Lee et al 1997;Apfelbaum et al 2000), nevertheless radio surgery cyberknife system could represent a feasible fi rst line option for TN in the close future, once its effectiveness has been robustly investigated, being it less costly than MVD, as emerged from this study.…”

“…Even though MVD represents the fi rst choice for those patients (Fujimaki et al 1990;Lee et al 1997;Apfelbaum et al 2000), less invasive procedures such as radiofrequency rhizotomy (Taha et al 1995;Kanpolat et al 2001;Tronnier et al 2001), glycerol rhizotomy (Lundsford et al 1984;Saini 1987;Burchiel 1988;Young 1988;North et al 1990), balloon compression (Brown et al 1993;Skirving et al 2001) and gamma knife stereotactic radio surgery (Kondziolka et al 1996;Rogers et al 2000;Maesawa et al 2001;Pollok et al 2002;Brisman et al 2002) are preferred for elderly patients suffering from signifi cant comorbidities, or with recurrent facial pain after prior surgery (Pollock et al 2005).…”

Классическая Невралгия Тройничного Нерва

“…Клиническая анато-мия ВМА детально изучена во второй половине прошлого века и посвящена особенностям идентификации отдельных ее сегментов на вертебральных ангиограммах с учетом ее анатомических вари-антов. В последние десятилетия в связи с внедрением в нейрохи-рургическую практику микроваскулярной декомпрессии корешка тройничного нерва для лечения больных НТН вновь возник инте-рес к изучению анатомии ВМА и ее взаимоотношению с КТН [201,202,203,282,287,288,289,384].…”