Long-term efficacy of microvascular decompression in trigeminal neuralgia

Abstract

Forty patients were followed for an average period of 8 1/2 years after 44 consecutive suboccipital craniotomies for trigeminal neuralgia. Among these patients, 36 had microvascular decompression (MVD) of the nerve, four had repeat trigeminal rhizotomy after MVD was not successful in controlling their pain, and four had primary trigeminal rhizotomies. Of the 36 patients undergoing MVD, 17 (47%) experienced recurrent postoperative neuralgic pain: in 11 (31%) pain recurrence was major, and in six (17%) it was minor. Among the eight patients undergoing rhizotomy, four (50%) had major pain recurrences and one (13%) had a minor recurrence, for a 63% total recurrence rate. There was a strong statistical relationship between an operative finding of arterial cross-compression of the nerve and long-term complete pain relief. Patients with other compressive pathology (related to veins or bone structures) did not on the average fare as well. Despite this, there appeared to be no point in time in the postoperative interval when the patient could be considered "cured." Major recurrences averaged 3.5% annually, and minor recurrences averaged 1.5% annually. The implications of these findings for the treatment of trigeminal neuralgia and the current understanding of the mechanism of MVD for this disorder are discussed.

Surgical treatment of trigeminal neuralgia: results of percutaneous treatment versus microsurgical decompression

“…In our series, microcompression of the gasserian ganglion was technically possible in 96.7% of cases, while TCG was completed in 84.1% of cases. Analyzing recent literature (1667 cases), Taha and Tew [11] reported 85% technical success after MVD procedures; similar rates were reported by Burchiel et al [18] (82%) and Walchenbach et al [7] (86%). Generally, the technical success through an MVD procedure is inferior to that through percutaneous procedures.…”

“…2. Literature data (Table 1) show equal acute success rates after both percutaneous and MVD procedures (total or subtotal remission of pain: TCG, 81.8%-95%; PMC, 79%-95.6%; MVD, 80%-100%) [5,8,10,11,13,17,18,[22][23][24]. A long-term analysis appears more difficult to perform due to differences in describing results and to variability of considered follow-up.…”

Percutaneous Radiofrequency Rhizotomy in Treatment of Trigeminal neuralgia: A Prospective Study

“…It is a minimally invasive and effective procedure that is especially indicated in older patients with that is Brown and Gouda [2] Burchiel et al [3] Rand [10] confined to the maxillary and mandibular divisions of trigeminal nerve with a low rate of recurrence. 2.…”

“…Unfortunately, the relief provided by Carbamazepine or other drugs may decrease over time, and side effects may necessitate discontinuation of the medication. About half the patients eventually require alternative procedures for pain relief [3].…”

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

“…A review of the literature reveals a wide range of recurrence rates of approximately 6%-41%. 5,6,8,10,11,22,23,25,[27][28][29]33,[36][37][38][39][41][42][43][44] Surgical alternatives after recurrence include repeat exploration for recurrent vascular compression and microvascular decompression (MVD), internal neurolysis, or radiofrequency lesioning. Other alternatives for recurrent TN include partial or complete sensory rhizotomy, balloon rhizotomy, glycerol injections, and radiosurgery.…”