Long-Term Efficacy of Nerve Combing for Patients with Trigeminal Neuralgia and Failed Prior Microvascular Decompression

Zhang, Xin; Xu, Ling; Zhao, Hua; Tang, Yinda; Zhu, Jin; Yuan, Yazhou; Zhou, Ping; Li, Shiting

doi:10.1016/j.wneu.2017.09.081

Cited by 20 publications

(14 citation statements)

References 17 publications

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“…Different from another ablative procedure, namely PSR, IN is performed longitudinally along nerve fibers without cutoff; thus, sensory dysfunction should be minor [2]. In our study, the results of follow-up indicate that IN is an effective treatment for TN without NVC, which is in accordance with previous publications [1, 3, 4]. However, there have been neither studies clearly illuminating the mechanism of IN, nor studies exploring prognostic factors for outcomes of IN.…”

Section: Discussionsupporting

confidence: 91%

“…However, there is still a large portion of MVD candidates that exhibits no NVC on MRI. On the other hand, there are frequent experiences that no new offending vessel is found during MVD for recurrent TN [1]. For these cases, internal neurolysis (IN) could be a new promising alternative treatment.…”

Section: Introductionmentioning

confidence: 99%

“…As a result, the extent of nerve injury with IN is much less than with partial sensory rhizotomy (PSR) [2] but more than with MVD. In recent case reports of IN, the efficacy of IN was 72–93%, and the rate of numbness or hypesthesia was 60–96% [1, 3-6]. …”

Section: Introductionmentioning

confidence: 99%

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Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Wu¹,

Jiang²,

Niu³

et al. 2018

Stereotact Funct Neurosurg

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Background: Internal neurolysis (IN) is an effective surgical treatment for trigeminal neuralgia (TN) without neurovascular compression (NVC) or postoperative recurrence. However, the trigeminal nerve is directly manipulated during the procedure, and there is a high incidence of trigeminocardiac reflex (TCR). The aim of this study was to retrospectively analyze the outcome of IN and to explore its relationship with the occurrence of intraoperative TCR. Methods: Surgical and anesthesia records of 27 TN patients who underwent surgical treatment with IN at our department between March 2010 and September 2016 were retrospectively analyzed. Patients were divided into 2 groups on the basis of the occurrence of TCR during surgery, and clinical characteristics were compared. Pain intensity was assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. Results: TCR was observed in 23 of 27 patients (85.2%); it manifested as obvious changes in mean arterial pressure and heart rate by at least 20% of the baseline values. Trigeminal nerve atrophy was found in 9 patients (33.3%). The immediate pain-free rate was 96.3%, and the “excellent” rate was 72.1% for follow-up, with a rate of numbness or hypesthesia of 97.1%. These outcomes were retrospectively compared between the TCR and non-TCR groups, and there was a nonsignificantly higher “excellent” rate in the TCR group than in the non-TCR group. Conclusions: This study demonstrated that IN is an effective treatment for TN without NVC and has a close relationship with intraoperative TCR. To our knowledge, this is the first research describing TCR during IN.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Wu¹,

Jiang²,

Niu³

et al. 2018

Stereotact Funct Neurosurg

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“…Ablative therapies, such as percutaneous radiofrequency thermocoagulation, balloon compression, and Gamma Knife surgery, as well as neurolysis, may leave patients with facial numbness, and the recurrence rate is high. 11, [18][19][20] MVD has been broadly accepted as definitive treatment for TN because it produces excellent results, including the preservation of vascular and neural function. However, TN recurs slightly more frequently than does hemifacial spasm.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Liu

Zhong

Xia

et al. 2020

J Neurol Surg B Skull Base

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Objectives Although microvascular decompression (MVD) has been widely accepted as an effective treatment of trigeminal neuralgia (TN), some patients have not been cured. To improve the postoperative outcome, the surgical procedure should be further refined. Design This is a retrospective study. Setting Present study conducted at a cranial nerve disorder center. Participants: Clinical data were collected from patients with TN who had undergone surgery in our center, including 685 who had undergone traditional MVD and 576 who had undergone the “MVD plus” procedure, in which any vessel attached to the trigeminal nerve was freed away (“nerve-combing”), which was followed by intraoperative neurolysis. Main Outcome Measures Postoperative outcomes and complications in the two groups were compared. Results Among patients who underwent traditional MVD, the rates of immediate relief and 1-year relief were 89.9 and 86.9%, respectively; among patients who underwent MVD plus group, these rates were 95.1 and 94.6%, respectively (p = 0.05). Patients who underwent MVD plus initially exhibited a higher rate of facial numbness (p < 0.05), but this finding decreased over time and reached the same level as that in the traditional MVD group within 3 months (p > 0.05). Conclusion Sufficient MVD with nerve-combing for the treatment of TN may produce a high rate of cure with less recurrence.

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“…[1][2][3] However, the cure rate of MVD for TN has varied from 79.6 to 89.1%. [4][5][6][7] Not all patients experience relief of TN symptoms after MVD. Some authors believe that there may still be "delay relief" within 1 year of surgery.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia

Huang

et al. 2019

J Neurol Surg B Skull Base

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Background Microvascular decompression (MVD) has been widely accepted as a definitive therapy for primary trigeminal neuralgia (TN). However, some patients may not experience relief of TN symptoms following surgery. In this study, the findings of redo MVD are discussed. Methods Between 2015 and 2017, 205 patients with primary TN underwent MVD surgery in Shanghai Tongren Hospital. Among these patients, 187 had immediate complete relief of symptoms, 8 improved apparently, and 10 reported no symptom relief. Of the 10 patients without relief, 6 underwent reoperation within 5 days, 2 underwent reoperation 3 months after the first procedure, and 2 refused to undergo reoperation. Results The symptoms of those patients who received reoperation disappeared immediately after the surgery. In the second operations, new conflict sites at the motor roots were found in five cases. The real offending vessels were the superior cerebellar artery (SCA) or branch of the SCA in seven cases and the petrosal vein in one case. The nerve was not decompressed completely in either of the two cases. At the 12-month follow-up, no recurrence was found. For the other two patients who did not have reoperation, their symptom persisted. Postoperative complications showed no significant differences between the first and second operations. Conclusion Compression of the motor roots might be one of the causes of TN. Thorough exploration of both sensory and motor roots of the trigeminal nerve is essential to performing a successful MVD operation. Early reoperation for resistant TN after MVD does not increase the incidence of complications.

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Long-Term Efficacy of Nerve Combing for Patients with Trigeminal Neuralgia and Failed Prior Microvascular Decompression

Cited by 20 publications

References 17 publications

Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Analysis of Failed Microvascular Decompression in Patients with Trigeminal Neuralgia

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