Surgical treatment of primary trigeminal neuralgia: comparison of the effectiveness between mvd and mvd+psr in a series of 210 patients

Abstract

AIm: To evaluate the effectiveness of microvascular-decompression (MVD) or MVD+partial-sensory-rhizotomy (PSR) on the treatment of primary trigeminal neuralgia (TN).mAterIAl and methOds: 210 TN patients were retrospectively studied, among which there're 142 cases underwent MVD and 68 cases underwent MVD+PSR. results:In MVD group, pain vanished in 128, obviously relieved in 9, and 137 cases were profited from MVD. In 82 cases with a follow-up over 2 years, pain vanished in 74, pain sometime occurred in 5 which could be relieved by oral medicine, 3 cases could not be controlled effectively by medicine. In MVD+PSR group, pain completely vanished in 67 cases, not changed in 1 case. In 47 cases with a follow-up over 2 years, pain sometime occurred in 2 which could be relieved by carbamazepine, the others were completely pain-free. The short-term pain-free rate of MVD+PSR group was obviously higher than MVD group(P<0.05), after a follow-up over 2 years, the former was still higher than the later, 95.7% and 90.2% respectively, without significant difference in statistics.COnClusIOn: MVD+PSR was obviously superior to MVD in completely eliminating pain in short-term period after operation, however, longer pain-free rate need even longer time to follow up. Identifying the responsible vascular exactly and handling it reasonably were key to both groups. BulGulAr: Mikrovasküler dekompresyonun uygulandığı 137 hastadan 128'inde ağrı giderilmiş, 9'unda ise ağrıda bariz bir azalma olmuştur. Olguların 82'sinin 2 yıllık takibinde; 74 olguda ağrı görülmedi, 5 olguda nadir ağrı oldu ve oral ilaçlar ile kontrol edilebildi, 3 olgunun ağrısı ise oral ilaçlar ile kontrol edilemedi. Mikrovasküler dekompresyonun yanı sıra parsiyel duyusal rizotomi yapılan hastalardan 67'sinde ağrı görülmedi, 1'inde ağrı değişmedi. Bu olguların 47'sinin 2 yıllık izleminde; 2 olguda ağrı oldu ve karbamazepin ile rahatladı, diğer olgularda ağrı görülmedi. Erken dönemde mikrovasküler dekompresyon+parsiyel duyusal rizotomi yapılan olgularda, sadece mikrovasküler dekompresyon yapılan olgulara göre ağrısız bir dönem elde edilmiştir (P<0.05). İki yıllık sonuçlar incelendiğinde mikrovasküler dekompresyon+parsiyel duyusal rizotomi olgularının % 95,7 sinde ağrı yok iken sadece mikrovasküler dekompresyon yapılan olguların % 90,2'sinde ağrı yoktu; ancak iki grup arasında anlamlı istatistiksel fark bulunmadı. KeywOrds sOnuÇ:Mikrovasküler dekompresyon+parsiyel duyusal rizotomi ile mikrovasküler dekompresyon karşılaştırıldığında: erken dönemde mikrovasküler dekompresyon+parsiyel duyusal rizotomi mikrovasküler dekompresyona daha üstündür; ancak uzun dönemli karşılaştırma yapmak için takip sürelerinin uzatılarak değerlendirme yapılması gereklidir. Her iki grup içinde sorumlu vasküler etiyolojinin çok iyi ortaya konarak incelenmesi gereklidir.

<p>The Long-Term Outcomes and Predictors of Microvascular Decompression with or without Partial Sensory Rhizotomy for Trigeminal Neuralgia</p>

“…3,8,14,17 For MVD+PSR, 69.5% of the patients had favorable long-term outcomes. In the study by Zhang et al 5 after 2 years of follow-up, the pain-free rate in the MVD+PSR group was 95.7%. The longer follow-up duration (an average of 6.1 years) in this study may be the cause of the above differences.…”

“…Because of the high incidence of postoperative facial dysesthesia and the high recurrence rate of TN, pure PSR has been used in recent years for patients without obvious intraoperative vascular compression. 4,5 Although many neurosurgeons have performed MVD combined with PSR (MVD+PSR) on some TN patients who are not suitable to undergo pure MVD, [5][6][7] only a few studies have reported the differences in postoperative outcomes between MVD and MVD+PSR. 5 In addition, while many studies have reported the prognostic factors associated with long-term outcomes after MVD, [8][9][10][11][12][13][14][15][16][17][18][19] few reports have reported the prognostic factors associated with long-term outcomes after MVD+PSR.…”

Efficacy and Prognostic Value of Partial Sensory Rhizotomy and Microvascular Decompression for Primary Trigeminal Neuralgia: A Comparative Study

“…It is believed that PSR method should be performed or nerve roots should be combed when vessels are not compressed [26]. MVD is an ideal surgical method which can effectively relieve pain.…”

Endoscopic vascular decompression in trigeminal neuralgia

“…Small intraneural veins can be sacrificed. Partial sensory root sectioning (81,79) or combing (29) may be preferred over extensive mobilization of the large culprit vein. Wrapping techniques (81) or longitudinal dissection of the vessel away from the nerve roots (30) has been described to be effective procedures to relieve TN caused by intraneural vessels.…”