Microvascular Decompression for Trigeminal Neuralgia: A Prospective, Multicenter Study

Abstract

BACKGROUND Microvascular decompression (MVD) is the most effective procedure for the long-term management of trigeminal neuralgia (TGN). However, retrospective and single-center studies are inherently biased, and there are currently no prospective, multicenter studies. OBJECTIVE To evaluate the short- and long-term outcomes and complications in patients with TGN who underwent MVD at specialized Japanese institutions. METHODS We enrolled patients with TGN who underwent MVD between April 2012 and March 2015. We recorded their facial pain grade and complications at 7 d (short term), 1 yr (mid-term), and 3 yr (long term) postoperatively. RESULTS There were 166 patients, comprising 60 men and 106 women (mean age 62.7 yr). Furthermore, 105 patients were aged over 60 yr. We conducted neuromonitoring in 84.3% of the cases. The complete pain relief, mortality, and complication rates at the short-term follow-up were 78.9%, 0%, and 16.3%, respectively. Overall, 155 patients (93.4%) completed the long-term follow-up, with the complete pain relief and complication rates of 80.0% and 5.2%, respectively. CONCLUSION In the hands of experienced neurosurgeons, MVD for TGN can achieve high long-term curative effects. In addition, complications are uncommon and usually transient. Our results indicate that MVD is an effective and safe treatment for patients with TGN, including elderly patients.

The Molecular Basis and Pathophysiology of Trigeminal Neuralgia

“…Surgical technique is also being improved over time. In a recent prospective cohort study, Mizobuchi and colleagues demonstrated complete pain relief in 80% of patients at three years follow-up, with their higher success rate attributed to transposing the causative vessel away from the trigeminal nerve with a prosthesis, rather than interposing a prosthesis between the vessel and nerve [ 126 ]. The authors in the same study also observed that an arterial compressive pattern better predicted a successful response when compared to patterns of compression due to venous structures or arachnoiditis [ 126 ].…”

Diplopia following microvascular decompression surgeries: illustrative cases

“… 2 Postsurgical side effects include tinnitus, hearing disturbances, vertigo, facial numbness and palsy, and diplopia. 3 , 4 Additionally, up to 30% of patients report recurrent pain 4 years after MVD surgery for TN. 1 Risk factors for eventual pain recurrence include age younger than 53 years at the time of surgery, symptoms lasting longer than 11.5 years, female sex, and pain on the left side.…”

“…In general, approximately 16% of patients undergoing MVD for TN will experience symptoms related to cranial nerve (CN) or cerebellar dysfunction. 4 The percentage of patients enduring postsurgical complications is decreased to approximately 5% after 3 years. 4 Such nerve dysfunction is likely due to direct physical interaction with the affected CNs.…”

“… 4 The percentage of patients enduring postsurgical complications is decreased to approximately 5% after 3 years. 4 Such nerve dysfunction is likely due to direct physical interaction with the affected CNs. Stretching of the CN, inadvertent trauma to the nerve, and acoustic trauma incited by the use of a drill have all been suggested as causative factors, particularly in explaining CN VIII–related symptoms after MVD.…”

“…Up to 3%–6% of patients with MVD reported immediate diplopia postoperatively, whereas only 1.3% cases of reported diplopia persisted for more than 3 years. 4 , 6 Diplopia also seems to depend on the type of compressive pattern; MVD involving the superior cerebellar artery (SCA) has shown lower rates of diplopia occurrence compared to MVD involving non-SCA arteries. 4 The likelihood of other postoperative complications (e.g., facial numbness) increases with the number of MVD revisions.…”