Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta-analysis of prospective comparative trials

Sharma, Ravi; Phalak, Manoj; Katiyar, Varidh; Borkar, Sachin A; Kale, Shashank Sharad; Mahapatra, Ashok Kumar

doi:10.4103/0028-3886.232342

Cited by 27 publications

(32 citation statements)

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“… 20 – 24 Sharma et al performed a systematic review and showed that the initial success rate with MVD for medically refractory TN was 96% (95% CI 93.3%–98.6%). 25 Obviously, radiofrequency thermocoagulation and MVD resulted in superior rates of pain relief when compared to the PRF treatment reported in this study. However, PRF as the nondestructive and more minimally invasive technique will be more easily accepted by patients than destructive treatment and more invasive open surgery.…”

Section: Discussionmentioning

confidence: 53%

Efficacy and safety of CT-guided percutaneous pulsed radiofrequency treatment of the Gasserian ganglion in patients with medically intractable idiopathic trigeminal neuralgia

Lv¹,

Jia²,

Shen³

et al. 2018

JPR

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BackgroundThere is a lack of prospective studies for the long-term results of percutaneous pulsed radiofrequency (PRF) of the Gasserian ganglion in the treatment of patients with medically refractory trigeminal neuralgia (TN).Methods and resultsWe prospectively observed the outcomes of 28 idiopathic TN patients (between July 2013 and July 2016) who received CT-guided percutaneous PRF treatment of the Gasserian ganglion. All of the patients had stopped responding to drug therapy before PRF treatment. The effective treatment standard was a reduction in the pain numeric rating scale (NRS) by ≥50% after the procedure. The postoperative NRS score decreased gradually from preoperative 7.6±0.8 months to 1.5±2.4, 0.2±0.4, 0.2±0.4, 0.1±0.4, and 0.1±0.4 at 1, 3, and 6 months and 1 and 2 years after the PRF treatment. The response rates at 1, 3, and 6 months were 85.7%, and the rates at 12 months and 2 years were maintained at 78.6%. No serious side effects were observed.ConclusionCT-guided PRF invention is an effective and safe technique for medically intractable idiopathic TN patients. This minimally invasive alternative treatment has the potential as a first-line therapy for TN.

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Section: Discussionmentioning

confidence: 53%

Efficacy and safety of CT-guided percutaneous pulsed radiofrequency treatment of the Gasserian ganglion in patients with medically intractable idiopathic trigeminal neuralgia

Lv¹,

Jia²,

Shen³

et al. 2018

JPR

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“…MVD is the first choice treatment for patients with primary TN who find it difficult to tolerate pain. 3 – 5 , 10 – 13 Usually, we perform MRI and MRTA prior to surgery to observe the relationship between the trigeminal nerve and the peripheral blood vessels. Using these methods, we successfully identified a responsible vessel prior to surgery for all 20 of our patients.…”

Section: Resultsmentioning

confidence: 99%

<p>Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note</p>

Sun

Wang

Cai

et al. 2020

JPR

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Purpose: Microvascular decompression (MVD) surgery is considered as an effective method with which to treat trigeminal neuralgia (TN). However, sometimes MVD surgery fails due to incomplete decompression of the responsible vessels caused by a poor visual field. In this study, we evaluated the benefits of endoscopic visualization and the value of full endoscopic vascular decompression (EVD) by describing the surgical results of 20 patients with TN after EVD. Patients and Methods: This was a retrospective study in a single institution of 20 patients with TN who received EVD between April 2018 and October 2019. All patients underwent EVD via the suboccipital retrosigmoid approach without microscopy at any stage. Abnormal muscle response (AMR) and brainstem auditory evoked potentials (BAEPs) were routinely monitored throughout the procedure. Follow-up was conducted by outpatient and telephone interviews. The degree of facial pain was graded using the Barrow Neurological Institute (BNI) pain intensity score; a BNI of 1 was considered as the best result while a BNI of 2 or 3 was considered as a satisfactory result. Follow-up time ranged from 8 to 24 months, with a mean of 18±4.36 months. Results: All 20 patients with severe preoperative pain (BNI of 5) achieved immediate relief or complete control of pain after surgery (BNI of 1 to 2). Vascular conflicts were observed during surgery in all of the patients. None of the patients experienced hearing loss, facial paralysis, intracranial infection, cerebrospinal fluid leakage, cerebral hemorrhage, or death, following the operation. Conclusion: When carried out by surgeons with endoscopic experience, EVD can provide a clear surgical field of view and reduce the risk of surgical injury. Our findings indicate that EVD is a safe and effective surgical method for the treatment of TN.

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“…A number of systematic reviews and meta-analyses compared GKRS with microvascular de-compression (MVD), which will be discussed below in connection with MVD, the only treatment that directly corrects the cause of TN in at least 50% of cases [ 70 , 71 , 72 , 73 , 74 , 75 , 76 ].…”

Section: Discussionmentioning

confidence: 99%

“…A more recent systematic review confirmed the previous findings that MVD results in a higher percentage of favorable results with a lower incidence of complications [ 73 ]. Another meta-analysis published in 2018 showed an even greater initial success rate of 96% (95% CI 93.3–98.6%) for MVD compared to 71.8% for GKRS [ 75 ]. The disparity in outcome with greater pain relief following MVD continued for long-term follow-up as well as for short-term effects [ 74 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

Gerwin

2020

IJERPH

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Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed. (1) Methods: Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included. (2) Discussion: The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15–20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP. (3) Conclusion: PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment.

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Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta-analysis of prospective comparative trials

Cited by 27 publications

References 1 publication

Efficacy and safety of CT-guided percutaneous pulsed radiofrequency treatment of the Gasserian ganglion in patients with medically intractable idiopathic trigeminal neuralgia

Efficacy and safety of CT-guided percutaneous pulsed radiofrequency treatment of the Gasserian ganglion in patients with medically intractable idiopathic trigeminal neuralgia

<p>Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note</p>

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

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