Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia

Background. The incidence of trigeminal neuralgia (TN) is 15 per 100,000 people per year. The effectiveness of the existing conservative methods of therapy does not exceed 50%. The use of carbamazepine doubles the frequency of depressive conditions, and 40% of suicidal thoughts. Purpose of the study. To evaluate the long-term results of microvascular decompression using video endoscopy in the treatment of patients with classical trigeminal neuralgia (cNTN) with paroxysmal facial pain. Methods. At the Federal Research and Clinical Center of the FMBA of Russia in the period from 2014 to 2019. 96 patients with cNTN were operated on in 62 (64%) of whom neuralgia was with paroxysmal facial pain, and in 34 (36%) - with constant pain. The average period from the onset of pain syndrome to surgery was 5 years (from 2 months to 15 years). The maximum pain intensity upon admission to the hospital according to the visual analogue scale (VAS) was 10 points, according to the BNI (Barrow Neurological Institute) pain syndrome scale - V. All patients underwent MIA of the trigeminal nerve root using Teflon, and in 9 patients during surgery used video endoscopic assistance. The average follow-up period after surgery was 3.4 1.7 years (from 1 to 5 years).Results. In all (100%) patients, pain was completely relieved after surgery (BNI - I). Excellent and good results after MVD within 5 years were achieved in 98% of patients (BNI - I-II). Facial hypesthesia, which does not bring discomfort and anxiety (BNI-II), developed in 8% (n = 5) of patients. The use of video endoscopy made it possible to identify vessels compressing the trigeminal nerve root with minimal traction of the cerebellum and cranial nerves. The development of cerebellar edema and ischemia occurred in one (1.6%) patient.Conclusion. The MVD method with video endoscopy is effective in the treatment of patients with cNTN with paroxysmal pain syndrome.

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Section: Discussionunclassified

Five-year result of Microvascular decompression using video endoscopy in the treatment of classic trigeminal neuralgia with paroxysmal pain syndrome

Vinokurov¹,

Kalinkin²,

Bocharov³

et al. 2020

Journal of Clinical Practice

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“…По данным E. Pressman и соавт. [26], частота осложнений после микроваскулярной декомпрессии может достигать 12%. В нашем наблюдении у 1 (0,03%) пациента в первые сутки после операции развились отек и ишемия мозжечка, что потребовало экстренного хирургического лечения в объеме резекции нежизнеспособных тканей и установки наружного вентрикулярного дренажа сроком на 96 ч. На 11-е сутки пациент выписан в удовлетворительном состоянии.…”

Section: оригинальные исследованияunclassified

Long-term results of microvascular decompression with video endoscopy in the treatment of patients with atypical trigeminal neuralgia

Vinokurov

Kalinkin

Bocharov

et al. 2023

Journal of Clinical Practice

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The frequency of occurrence of atypical trigeminal neuralgia (aNTN) varies from 1 to 7 people per 100,000 population per year. The main cause of development is compression of the trigeminal nerve root (TN) by a vein and/or artery in the cerebellar cistern. To date, the final tactics of treatment of patients with aNTN have not been determined. The effectiveness of conservative methods of therapy does not exceed 50%. The aim of the study was to evaluate the results of microvascular decompression using video endoscopy in the treatment of patients with atypical trigeminal neuralgia. Methods. In the period from 2014 to 2021 34 patients with atypical HTN were operated on, of which 18 (53%) patients had neuropathic pain (more than 4 points on the DN4 scale), and 15 (44%) patients had a transformation of classical trigeminal neuralgia into atypical. Conservative therapy (carbamazepine, gabapentin, pregabalin), administered to all patients in the preoperative period, was not accompanied by a significant reduction in pain syndrome. The maximum intensity of pain upon admission to the hospital according to the visual analog scale (VAS) was 10 points, according to the severity of pain syndrome BNI (Barrow Neurological Institute) V (severe, persistent pain). All patients underwent internal affairs of the trigeminal nerve root with the use of Teflon; in 12 (35%) patients, in addition to a microscope, video endoscopy was additionally used. The average follow-up period after surgery was 3.4 1.7 years (from 1 to 5 years). Results. In all (100%) patients after surgery, the pain is completely stopped (BNI I). The total fiveyear excellent and good outcome of the disease on the J.Miller and BNI scale (I-II) was noted in 80% (n=27) of patients with atypical NTN. The risk of pain recurrence in the first three years after MVD was 14% (n=3), and after 5 years 34% (n=4). The use of video endoscopy made it possible to identify vessels compressing the root of the trigeminal nerve with minimal displacement of the cerebellum and cranial nerves when visualizing neurovascular conflict. Conclusion. The MVD method with video endoscopy is effective in the treatment of patients with aNTN

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“…Identification of a compressive artery allows for the placement of a Teflon (polytetrafluoroethylene) or Ivalon (polyvinyl alcohol) pledget to separate the nerve from the offending artery. 253 Others have reported the creation of a sling with sutures, glue, 254 or the tentorium as a method of arterial decompression. 255 In cases where a vein is causing trigeminal compression, bipolar cautery is used to divide the vein.…”

Section: Open Surgerymentioning

confidence: 99%

Trigeminal Neuralgia: Current Approaches and Emerging Interventions

Xu¹,

Xie²,

Jackson³

2021

JPR

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Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia

Cited by 14 publications

References 38 publications

Five-year result of Microvascular decompression using video endoscopy in the treatment of classic trigeminal neuralgia with paroxysmal pain syndrome

Five-year result of Microvascular decompression using video endoscopy in the treatment of classic trigeminal neuralgia with paroxysmal pain syndrome

Long-term results of microvascular decompression with video endoscopy in the treatment of patients with atypical trigeminal neuralgia

Trigeminal Neuralgia: Current Approaches and Emerging Interventions

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