Nationwide Shift From Percutaneous Rhizotomy to Microvascular Decompression for Treatment of Trigeminal and Other Cranial Nerve Neuralgias

Abstract

Objective The aim of this study was to report the trends in the use of common surgical interventions over the past decade to treat cranial nerve neuralgias. Methods The Centers for Medicare and Medicaid Services Part B National Summary Data File from 2000 to 2016 were studied. Results A total of 57.1 million persons were enrolled in 2016, up from 39.6 million persons in 2000. Suboccipital craniectomy done for cranial nerve decompressions (including cranial nerves V, VII, and IX) increased by 33.9 cases per year so that in 2016 the number of cases was 167% of what it was 17 years earlier (ie, from 655 cases in 2000 to 1096 cases in 2016). The less commonly used subtemporal approach craniectomy to treat trigeminal neuralgia (TN) increased by 1.13 cases per year (ie, from 25 cases in 2000 to 46 cases in 2016). The less invasive percutaneous rhizotomy procedures, including glycerol and radiofrequency ablation, for treatment of TN decreased by 42.9 cases per year (64%; ie, from 2578 cases in 2000 to 1206 cases in 2016). Conclusions Overall trends show increased use of open surgery and decreased use of percutaneous rhizotomy, including destruction of the trigeminal nerve using balloon compression, glycerol injection, or thermal injury. These trends may be related to differences in outcomes between treatment modalities.

Comparative analysis of anesthesia and clinical efficacy of inhalation anesthesia and intravenous anesthesia in Trigeminal Nerve Balloon Avulsion

“…In the wake of the improvement of technology and the emergence of new materials in recent years, percutaneous trigeminal nerve balloon avulsion has gradually been widely used. 7 It has become the preferred method for the treatment of TN due to its advantages of simple operation, short learning period, minimally invasive, rapid and efficient, short hospital stay and low cost. This approach is particularly well suited for those with trigeminal neuralgia who are unable or unwilling to undergo craniotomy and have severe underlying diseases.…”

Outcomes using linear accelerator stereotactic radiosurgery for the treatment of trigeminal neuralgia: A single-center, retrospective study

“…Other subtypes have also been recognized that involve continuous facial pain (Type 2) or pain related to demyelinating disorders. [ 2 , 8 ] Although treatment with microvascular decompression (MVD) has become more common over the past decade,[ 15 , 25 ] noninvasive modalities of treatment such as stereotactic radiosurgery (SRS) may be a favorable option for those patients who refuse invasive surgery or are not able to tolerate open surgical treatment.…”

Avaliação comparativa dos efeitos da termocoagulação por radiofrequência e neurotomia percutânea com balão no controle da dor a longo prazo em pacientes com neuralgia trigeminal idiopática

“…Following a series of excellent outcomes, microvascular decompression (MVD) became the gold-standard in treating TN patients, especially in cases with proven pre-operative nerve deformity caused by vascular anomaly (Barker et al, 1996). It is expected that MVD led to 95% of relief and a rate of recurrence of 1% per-year (Tatli et al, 2008;Kundu and Rolston, 2018).…”

“…Since trigeminal ganglion procedures are less invasive and available, they became the intervention of choice in most pain centers (Sweet, 1975;Apfelbaum, 1977;Lichtor and Mullan, 1990;Tronnier et al, 2001;Teixeira et al, 2006;Baabor and Perez-Limonte, 2011;Koopman et al, 2011;Kundu and Rolston, 2018). Up to 80% of the subjects treated with BC and RF may be free of pain depending on the follow-up period (Kanpolat et al, 2001;Bendtsen et al, 2019;Jones et al, 2019), although the end-points are not clear in the literature.…”