Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence

Sun, Tengyang; Saito, S; Nakai, Osamu; Ando, Tadashi

doi:10.1007/bf01476425

Cited by 89 publications

(54 citation statements)

References 20 publications

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“…This last point was criticized by Klun [26] in whose experience no data matching symptoms duration with the postoperative success were evident. More general agreement is evident concerning the analysis of correlation between an unclear neurovascular conflict and pain persistence or recurrence [10,26,27]. In our study no outcome differences were observed between cases harboring a clear or an unclear neurovascular conflict.…”

Section: Discussionsupporting

confidence: 79%

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

et al. 2000

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A patient with trigeminal neuralgia may need different forms of treatment during his or her lifetime. Physicians should be aware of the different available surgical treatments, and know their effectiveness, side effects and complications. Microvascular decompression is considered by many to be the most effective treatment. The goal of the procedure is to remove the cause of pain, obtained by decompressing the nerve at its entry point into the pons. Percutaneous procedures are more easily performed but the recurrence rate of pain is higher. It is difficult to compare the results of surgical procedures reported by different authors. Therefore, we compare the efficacy of 155 microvascular decompressions with 113 radiofrequency thermocoagulations and 215 percutaneous microcompressions performed by the same surgical team. Our study confirms microvascular decompression as the most effective surgical treatment, although percutaneous procedures play an important role in the treatment protocol and have to be offered to patients as a therapeutic option.

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Section: Discussionsupporting

confidence: 79%

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

et al. 2000

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“…Of the 61 patients, 10 (16%) had recurrence within 2 years of surgery. 38 Tronnier et al reviewed 225 cases in which patients were treated with MVD and found that 63% of the patients had 20 years of pain relief. 41 Sindou et al evaluated 120 patients after MVD, with a mean followup period of 41 months; 83.3% and 79% of patients had pain relief from sitting craniotomy and lateral approach, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Lee¹,

McCartney²,

Burbidge³

et al. 2014

JNS

117

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Object Vascular compression of the trigeminal nerve is the most common factor associated with the etiology of trigeminal neuralgia (TN). Microvascular decompression (MVD) has proven to be the most successful and durable surgical approach for this disorder. However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence. Methods The authors performed a retrospective review of cases of TN Type 1 (TN1) or Type 2 (TN2) involving patients 18 years or older who underwent evaluation (and surgery when indicated) at Oregon Health & Science University between July 2006 and February 2013. Surgical and imaging findings were correlated. Results The review identified a total of 257 patients with TN (219 with TN1 and 38 with TN2) who underwent high-resolution MRI and MR angiography with 3D reconstruction of combined images using OsiriX. Imaging data revealed that the occurrence of TN1 and TN2 without NVC was 28.8% and 18.4%, respectively. A subgroup of 184 patients underwent surgical exploration. Imaging findings were highly correlated with surgical findings, with a sensitivity of 96% for TN1 and TN2 and a specificity of 90% for TN1 and 66% for TN2. Conclusions Magnetic resonance imaging detects NVC with a high degree of sensitivity. However, despite a diagnosis of TN1 or TN2, a significant number of patients have no NVC. Trigeminal neuralgia clearly occurs and recurs in the absence of NVC.

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“…Recurrence can be ascribed to the postoperative fibrotic adhesions formed around the nerve [56], to the intrinsic lesion [67] and especially to the absence of NVC.…”

Section: Is Mvd the Definitive Treatment For Tn?mentioning

confidence: 99%

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

Orlandini¹

2002

J Headache Pain

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IntroductionTrigeminal neuralgia (TN) can be managed by medical and surgical treatment. Half of the patients are cured by drugs (particularly carbamazepine) without side effects, 25% are cured but have intolerable side effects and 25% are not cured [1]. Then, half of the patients require surgical treatment. When drugs become ineffective or not tolerated, the question of which intervention (percutaneous or open) is appropriate becomes an important issue. Among modern operations, three are percutaneous (trigeminal percutaneous Guido OrlandiniAbstract The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients because of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux. Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple arterial loop and neurovascular contact. Probably, many immediate failures and early relapses are the consequence of the inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate selection can be explained by the difficult preoperative diagnosis of NVC in the past.Indeed, angiography and computed tomography showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with the following: (1) percutaneous techniques are indicated for patients without demonstrated NVC (including patients with TN in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and (2) MVD is indicated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor this operation desiring no sensory deficit.

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Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence

Cited by 89 publications

References 20 publications

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

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

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

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