Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients

Abstract

Background Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD. Objectives We aimed to assess outcome and complications after microvascular decompression from our center. Methods We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors. Results Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others. Conclusion Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively. Trial registration Clinical.trials.gov registration no. NCT04445766.

Efficacy of surgical treatment in patients with trigeminal neuralgia secondary to multiple sclerosis: A prospective study of 18 cases with evaluation of outcome and complications by independent evaluators

“…Microvascular decompression. MVD was conducted as outlined in our previous publication concerning patients with classical and idiopathic TN (27). We only considered MVD when NVC was detected on presurgical MRI.…”

“…Surgical complications were graded as major or minor according to a predefined protocol described in detail elsewhere (27). Major complications were defined as death, ischaemic or haemorrhagic cerebellar or brainstem stroke, anaesthesia dolorosa, meningitis, cerebrospinal fluid leak, hydrocephalus, permanent ataxia, permanent diplopia, corneal keratitis, permanent severe hypoesthesia, permanent facial nerve palsy, permanent hearing loss or permanent hearing impairment.…”

“…Outcome and complications after MVD and percutaneous procedures (BC and GR). For a graphical illustration of the differences across groups and procedures our data from patients with MS-TN on MVD outcome (a) and complications (b) and outcome (c) and complications (d) following percutaneous procedures are presented, with data on MVD outcome (e) and complications (f) from a recently published study 27 using the same methodology in CTN and ITN (n = 115) with NVC.…”

“…This is an important finding and highly indicative of NVC with morphological changes being a positive prognostic factor when it comes to efficacy of MVD in MS-TN. NVC is probably the primary cause of TN in patients with classical TN, and consequently many patients with classical TN obtain not only a good but an excellent outcome after microvascular decompression (5,18,25,27). In a recent paper from our center using the same methodology as the present study on the two-year outcome after MVD in patients with idiopathic with simple NVC (i.e.…”

Percutaneous glycerol rhizolysis of the trigeminal ganglion for the treatment of idiopathic and classic trigeminal neuralgia: Outcomes and complications

“…Existing data favor microvascular decompression (MVD) for cTN (i.e., morphological changes of the trigeminal nerve root by an artery) [2][3][4][5][6]. The results of MVD for iTN patients with absent arterial contact or venous contact only and cTN patients with morphological changes secondary to venous compression or distortion are less favorable, and MVD is not routinely recommended for these patients at our institution [4,5,[7][8][9]. While percutaneous glycerol rhizolysis (PGR) of the trigeminal ganglion (TG) under fluoroscopy and other ablative treatments (e.g., stereotactic radiosurgery of the trigeminal nerve, balloon rhizolysis of the TG, radiofrequency ablation of the TG) have a definite role in the management of various types of TN, the role of PGR of the TG for iTN patients with absent arterial contact or venous contact only and cTN patients with morphological changes secondary to venous compression or distortion has never been reported.…”