Effect of Microvascular Decompression in Trigeminal Neuralgia Patients With or Without Constant Pain

Sandell, Tiril; Eide, Per Kristian

doi:10.1227/01.neu.0000335075.16858.ef

Cited by 67 publications

(40 citation statements)

References 13 publications

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“…The positive outcome rate we measured (93%) is at the high range of those generally reported in the literature 9,10 . While average duration of follow-up in this series is small, patients are routinely not seen in clinic following the 6-week visit if they remain pain-free and asymptomatic.…”

Section: Discussionsupporting

confidence: 66%

“…The use of intraoperative auditory brainstem evoked potentials, in particular, has lessened surgical morbidity by monitoring for early irritation of the brainstem and cranial nerves and assisting in prevention of damage to these structures 8 . Recent reports estimate positive outcome rates of MVD for trigeminal neuralgia in the ranges of 77-94% 9,10,11 . Nevertheless, significant postoperative complications, namely CSF leak, cerebellar damage and hearing loss 9,10 , still occur with the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports estimate positive outcome rates of MVD for trigeminal neuralgia in the ranges of 77-94% 9,10,11 . Nevertheless, significant postoperative complications, namely CSF leak, cerebellar damage and hearing loss 9,10 , still occur with the procedure. Additionally, recurrence of symptoms has been reported to occur in as many as 39% of patients 10,11 following this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, significant postoperative complications, namely CSF leak, cerebellar damage and hearing loss 9,10 , still occur with the procedure. Additionally, recurrence of symptoms has been reported to occur in as many as 39% of patients 10,11 following this procedure. In addition to being correlated with intraoperative variables such as nerve location, blood vessel, type and duration of symptoms 6,7 , the rate of recurrence also has been correlated with experience of the surgeon and hospital in performing MVD 12 .…”

Section: Discussionmentioning

confidence: 99%

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Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Forbes

Cooper

Jermakowicz

et al. 2011

JoVE

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Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of the trigeminal nerve. Previous reports indicate that 80-90% of cases are related to compression of the trigeminal nerve by an adjacent vessel. The majority of patients with trigeminal neuralgia eventually require surgical management in order to achieve remission of symptoms. Surgical options for management include ablative procedures (e.g., radiosurgery, percutaneous radiofrequency lesioning, balloon compression, glycerol rhizolysis, etc.) and microvascular decompression. Ablative procedures fail to address the root cause of the disorder and are less effective at preventing recurrence of symptoms over the long term than microvascular decompression. However, microvascular decompression is inherently more invasive than ablative procedures and is associated with increased surgical risks. Previous studies have demonstrated a correlation between surgeon experience and patient outcome in microvascular decompression. In this series of 59 patients operated on by two neurosurgeons (JSN and PEK) since 2006, 93% of patients demonstrated substantial improvement in their trigeminal neuralgia following the procedure-with follow-up ranging from 6 weeks to 2 years. Moreover, 41 of 66 patients (approximately 64%) have been entirely pain-free following the operation.In this publication, video format is utilized to review the microsurgical pathology of this disorder. Steps of the operative procedure are reviewed and salient principles and technical nuances useful in minimizing complications and maximizing efficacy are discussed. Video LinkThe video component of this article can be found at https://www.jove.com/video/2590/ Protocol 1. Positioning 1. Positioning is an integral component of microvascular decompression. Following induction of anesthesia, the patient is placed in pins while on the operating room table and moved to the lateral park bench position with side of the desired MVD placed up. Of note, JSN prefers to insert a lumbar drain prior to the procedure to allow greater control of intra-op drainage of CSF and cerebellar relaxation (the drain is then removed when the patient is discharged, often on POD2). 2. All pressure points are padded and an axillary roll is placed. The patient's chest and hips are taped securely to the table to allow rotation of the table, if necessary, later in the case. The patient's shoulder is taped down for purposes of visualization. The head is rotated approximately 10-15 degrees away from the affected side and the neck is flexed slightly so that the planned surgical trajectory is now almost orthogonal to the floor. The vertex is tilted slightly down. Special attention is made to ensure that there no pathologic compression of venous drainage from the head. Specifically, there should be room for at least two finger breadths between the mandible and upper thorax. Head rotation should not exceed 30 degrees. 3. c. The body is secured prior to three-point head fixation. Electrophysi...

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Forbes

Cooper

Jermakowicz

et al. 2011

JoVE

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“…Growing neurosurgical data advocate the distinction of these two subtypes of TN into type 1 as defined as >50% episodic onset of TN pain and type 2 defined by >50% constant pain Limonadi et al 2006]. The mechanisms associated with the development of this persistent pain are not well understood but concomitant background pain is associated with poor medical and surgical outcome [Obermann et al 2008;Sandell and Eide, 2008;Szapiro et al 1985]. Recent investigations focused on the suspected central component in the pathophysiology of TN, which could involve central allodynic mechanisms that may also engage the nociceptive neurons at thalamic and cortical level [Obermann et al 2007].…”

Section: Introductionmentioning

confidence: 99%

Treatment options in trigeminal neuralgia

Obermann

2010

Ther Adv Neurol Disord

170

133

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The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options.

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Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia

Degn

Brennum

2010

Acta Neurochir

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Regarding prognosis and outcome, we find that it is very important to classify TN in subgroups (types 1 and 2). Dealing with medically treatment-resistant type 1 TN, MVD and RIZ are reasonably safe and effective interventions. The surgical results dealing with type 2 TN are still very poor. All patients with medically treatment-resistant TN should be offered referral to a neurosurgical unit with experience in treating this painful disease. We recommend using a vector-based pain diagram when evaluating the outcome of multiple interventions.

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Effect of Microvascular Decompression in Trigeminal Neuralgia Patients With or Without Constant Pain

Abstract: In TN patients with constant pain before MVD, significant relief of episodic and constant pain was observed in 81 and 77%, respectively. Hence, the presence of constant pain should not prevent TN patients from being offered MVD.

Cited by 67 publications

References 13 publications

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Treatment options in trigeminal neuralgia

Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia

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