Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls

Abstract

There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. methods The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). results Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001). coNclusioNs Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

Quantitative Sensory Changes Following Gasserian Ganglion Radiofrequency Thermocoagulation in Patients with Medical Refractory Trigeminal Neuralgia: A Prospective Consecutive Case Series

“…Interestingly, there was a postinterventional drop tendency of mean MDT z scores from -4.27 to -7.58 at follow-up (p ¼ 0.15) that was also identified in another case-control longitudinal study after trigeminal ganglion balloon compression, but not following MVD. 30,36 The same study refers to increased cold and warm thresholds after MVD and balloon compression that is not supported by our data concerning RFT.…”

Biomarkers in temporomandibular disorder and trigeminal neuralgia: A conceptual framework for understanding chronic pain

“…A study of patients with TN before and after decompression surgery found that although pain and masticatory function improved after surgery, QST identified the development of subtle new sensory deficits following surgery. 134 QST could also serve as a predictive biomarker, forecasting potential efficacy to various treatment options.…”

Orofacial neuropathic pain

“…There are cases when pain returns without apparent reasons [10][11][12][13][14][15][16][17] . Pain episodes cause extreme jaw restriction, including daily functions such as swallowing, speaking and teeth-brushing; sensory abnormalities are also frequent in these patients 18 . The IHS 7 has included two other conditions with similar clinical expression: painful trigeminal neuralgia due to multiple sclerosis (differentiated by disease diagnosis and for not being mandatorily bilateral) and painful trigeminal neuropathy attributed to injury (caused by invasive process in the region of the trigeminal nerve).…”

“…Among them, microvascular decompression has excellent long term results, although with increased surgery-inherent risks. There are less adverse effects on the masticatory system as compared to trigeminal ganglion balloon compression 18 which is a surgical percutaneous modality that can be used to treat TN 20 . Anesthetic block during balloon compression may decrease intraoperative complications 30 .…”