Microvascular Decompression and Partial Sensory Rhizotomy in the Treatment of Trigeminal Neuralgia

Klun, B.

doi:10.1097/00006123-199201000-00009

Cited by 51 publications

(77 citation statements)

References 12 publications

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“…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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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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“…These authors indicated a worse long-term prognosis correlated to other factors, such as the lack of an immediate postoperative disappearance of pain, the presence of an unclear neurovascular conflict and preoperative signs lasting more than eight years. 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].…”

Section: Discussionmentioning

confidence: 99%

“…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: Discussionmentioning

confidence: 99%

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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“…Clinical studies show that the most common vessel causing trigeminal conflict is the superior cerebellar artery (SCA) (66-88%) [7,11,22], less often the AICA (7.5-25%) [11,22], vein vessels (5.5--13%) [1,22] and intermittently the vertebral artery with the BA (1.1-3.5%) [11,22], and the posterior cerebellar artery (0-1.0%) [1,11]. In the anatomical study based on the examination of 50 cadaver heads, Hardy and Rhoton et al [8] showed the arterial conflict in 58% of all specimens, and in 87% it concerned SCA.…”

Section: Analysis Of the Anatomical Variations Of Neurovascular Conflictmentioning

confidence: 99%

“…The percentage is approximately 0-28%, and it depends on the number of microdecompression series [1,11,17,21,23,25,30]. It is the cause why they have concluded that vascular compression may be the predominant, but not the sole cause of TGN and the pathophysiology of pain is still unclear [12,21,23].…”

Section: Analysis Of the Anatomical Variations Of Neurovascular Conflictmentioning

confidence: 99%

Trigeminal neuralgia caused by aneurysm of the posterior cerebral artery: a case description and the analysis of anatomical variety of vascular complex in the rood entry zone of trigeminal nerve

Dzierżanowski

Słoniewski

2014

Folia Morphol

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Microvascular Decompression and Partial Sensory Rhizotomy in the Treatment of Trigeminal Neuralgia

Cited by 51 publications

References 12 publications

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression

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

Trigeminal neuralgia caused by aneurysm of the posterior cerebral artery: a case description and the analysis of anatomical variety of vascular complex in the rood entry zone of trigeminal nerve

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