Meta-Analysis on Safety and Efficacy of Microsurgical and Radiosurgical Treatment of Trigeminal Neuralgia

Gubian, Arthur; Rosahl, Steffen K.

doi:10.1016/j.wneu.2017.04.085

Cited by 46 publications

(25 citation statements)

References 86 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two recently published meta-analyses have established the superiority of MVD as a primary treatment over GKRS due to higher initial pain-free rates and long-term pain-free rates. 9,17 However, the role of MVD after failure of other procedures has been less clearly established than its role as a primary procedure. The primary mechanism by which MVD produces pain relief in patients with vascular compression (reversal of physiological changes produced by demyelination) is altered with prior ablative procedures, including GKRS.…”

Section: Role Of Repeat Gkrs In Tnmentioning

confidence: 99%

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Patra¹,

Savardekar²,

Dossani³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEGamma Knife radiosurgery (GKRS) has emerged as a promising treatment modality for patients with classical trigeminal neuralgia (TN); however, considering that almost half of the patients experience post-GKRS failure or lesion recurrence, a repeat treatment is typically necessary. The existing literature does not offer clear evidence to establish which treatment modality, repeat GKRS or microvascular decompression (MVD), is superior. The present study aimed to compare the overall outcome of patients who have undergone either repeat GKRS or MVD after failure of their primary GKRS; the authors do so by conducting a systematic review and meta-analysis of the literature and analysis of data from their own institution.METHODSThe authors conducted a systematic review and meta-analysis of the PubMed, Cochrane Library, Web of Science, and CINAHL databases to identify studies describing patients who underwent either repeat GKRS or MVD after initial failed GKRS for TN. The primary outcomes were complete pain relief (CPR) and adequate pain relief (APR) at 1 year. The secondary outcomes were rate of postoperative facial numbness and the retreatment rate. The pooled data were analyzed with R software. Bias and heterogeneity were assessed using funnel plots and I2 tests, respectively. A retrospective analysis of a series of patients treated by the authors who underwent repeat GKRS or MVD after post-GKRS failure or relapse is presented.RESULTSA total of 22 studies met the selection criteria and were included for final data retrieval and meta-analysis. The search did not identify any study that had directly compared outcomes between patients who had undergone repeat GKRS versus those who had undergone MVD. Therefore, the authors’ final analysis included two groups: studies describing outcome after repeat GKRS (n = 17) and studies describing outcome after MVD (n = 5). The authors’ institutional study was the only study with direct comparison of the two cohorts. The pooled estimates of primary outcomes were APR in 83% of patients who underwent repeat GKRS and 88% of those who underwent MVD (p = 0.49), and CPR in 46% of patients who underwent repeat GKRS and 72% of those who underwent MVD (p = 0.02). The pooled estimates of secondary outcomes were facial numbness in 32% of patients who underwent repeat GKRS and 22% of those who underwent MVD (p = 0.11); the retreatment rate was 19% in patients who underwent repeat GKRS and 13% in those who underwent MVD (p = 0.74). The authors’ institutional study included 42 patients (repeat GKRS in 15 and MVD in 27), and the outcomes 1 year after retreatment were APR in 80% of those who underwent repeat GKRS and 81% in those who underwent MVD (p = 1.0); CPR was achieved in 47% of those who underwent repeat GKRS and 44% in those who underwent MVD (p = 1.0). There was no difference in the rate of postoperative facial numbness or retreatment.CONCLUSIONSThe current meta-analysis failed to identify any superiority of one treatment over the other with comparable outcomes in terms of APR, postoperative facial numbness, and retreatment rates. However, MVD was shown to provide a better chance of CPR compared with repeat GKRS.

show abstract

Section: Role Of Repeat Gkrs In Tnmentioning

confidence: 99%

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Patra¹,

Savardekar²,

Dossani³

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…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%

“…Patients in the PSR treatment group had more post-operative complications and of greater severity than those treated by MVD, including pain, numbness, dysesthesias, and difficulty eating [ 82 ]. MVD was compared to GKRS in a meta-analysis that looked at 414 studies of GKRS, 12 MVD and 5 of both types of treatments, published between 2005 and 2015 [ 76 ]. The type of MVD was not indicated in this study, and both EMVD and OMVD were included.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…It is etiologically caused by vascular compression of the trigeminal root, no matter directly or indirectly pushed by neoplasms or adhesions in the cerebellopontine angle [6][7][8]. It was speculated that an ephaptic transmission or ectopic impulse occurred at the micro-injury site of the trigeminal nerve fibers compressed by a vessel [9]. Whatever, it has been widely accepted that the at the vascular compressed site is the precondition of TN generation [10].…”

Section: Introductionmentioning

confidence: 99%

A Feasibility Research on Restoration of Demyelination in Trigeminal Nerve with Transnasal Administration of BDNF/ NGF Loading on PEG-PLA Nanoparticles

Xia¹,

Zhong²,

Liu³

et al. 2018

Neuropsychiatry

View full text Add to dashboard Cite

Background Trigeminal neuralgia (TN) is caused by the vascular compression of the Vth cranial nerve root, where the pathology of demyelination has been observed. Although microvascular decompression surgery has become the most reasonable technique for the treatment, this sort of operation is with risk and invasive. Accordingly, we attempt to find a noninvasive approach to treat TN. Preparation of PEG-PLA nanoparticles loaded with BDNF or NGF PEG-PLA nanoparticles (NP) were prepared by the emulsion/solvent evaporation method. Briefly, MePEG-PLA (22.5 mg) and Male-PEG-PLA (2.5 mg) were gifted from Sichuan university of electronic science and technology and were dissolved in 1 ml of dichloromethane and added The CCK-8 and Immunostaining of S-100 experiments indicated that the BDNF-NPs or NGF-NPs could promote the expression of Schwann cells (p<0.05). Conclusions The study demonstrated that BDNF/NGF loading on nanoparticles may transmit along with the trigeminal nerve via nasal administration and facilitate the restoration of myelin sheath. It could be a sort of noninvasive remedy for trigeminal neuralgia.

show abstract

Meta-Analysis on Safety and Efficacy of Microsurgical and Radiosurgical Treatment of Trigeminal Neuralgia

Cited by 46 publications

References 86 publications

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

Repeat Gamma Knife radiosurgery versus microvascular decompression following failure of GKRS in trigeminal neuralgia: a systematic review and meta-analysis

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

A Feasibility Research on Restoration of Demyelination in Trigeminal Nerve with Transnasal Administration of BDNF/ NGF Loading on PEG-PLA Nanoparticles

Contact Info

Product

Resources

About