Microvascular decompression in patients with trigeminal neuralgia and multiple sclerosis: results and analysis of possible prognostic factors

Montano, Nicola; Rapisarda, Alessandro; Ioannoni, Eleonora; Olivi, Alessandro

doi:10.1007/s13760-019-01258-5

Cited by 20 publications

(15 citation statements)

References 32 publications

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“…The general advice in these patients would be to consider microvascular decompression if the MR scan shows morphological changes and in absence of a plaque in the pons, given that very recent evidence suggested that a brainstem lesion related to the TN on MR is a negative prognostic factor for microvascular decompression. 40 Trigeminal microvascular decompression is a major procedure that can be carried out successfully in the elderly provided they have no significant comorbidities, but results are poorer in those younger than 25 years. Severe complications are rare but there is small risk of mortality (0.3%).…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Trigeminal neuralgia: a practical guide

2021

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Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.

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Section: Surgical Treatmentsmentioning

confidence: 99%

Trigeminal neuralgia: a practical guide

2021

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“…MS has been categorized into four distinct clinical subtypes: relapsing-remitting, secondary-progressive, primary progressive, and progressive relapsing [ 17 ]. However, all types of MS show a neuroaxonal dysfunction determining, among the others, weakness, visual impairment, bladder dysfunction, sensory impairment, fatigue, spasticity of the extremities, trigeminal neuralgia, and neuropathic pain, which is found in approximately 50% of MS patients [ 18 – 20 ]. These symptoms may become unresponsive to the medical management and may significantly worsen the quality of life of these patients [ 2 , 5 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Is There a Place for Spinal Cord Stimulation in the Management of Patients with Multiple Sclerosis? A Systematic Review of the Literature

Rapisarda

Ioannoni

Izzo

et al. 2021

Minimally Invasive Surgery

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Objective. Spinal cord stimulation (SCS) is a minimally invasive technique mainly used to treat neuropathic pain associated with failed back surgery syndrome. However, this therapy has been utilized to treat other chronic painful conditions, such as pain associated with multiple sclerosis (MS). Nonetheless, the efficacy of SCS in MS patients has not been fully established. In fact, in most of SCS series, MS patients represent only a subset of a bigger cohort which comprises different causes of pain, motor disorder, and other functional limitations. The aim of our study was to systematically review the literature to evaluate the effectiveness of SCS in MS patients. Methods. A literature search was performed through different databases (PubMed, Scopus, and Embase) using the following terms: “multiple sclerosis,” “spinal cord stimulation,” and “dorsal column stimulation,” according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Results. A total of 452 articles were reviewed, and 7 studies were included in the present analysis. 373 MS patients were submitted to a stimulation trial, and 82 MS patients underwent a de novo implantation. 285/373 (76.4%) of cases submitted to the SCS trial were enrolled for permanent stimulation. We found a long-lasting improvement in 193/346 (55.8%) MS patients with motor disorders, in 90/134 (67.13%) MS patients with urinary dysfunction, and in 28/34 (82.35%) MS patients with neuropathic pain. The efficacy of SCS was higher for urinary dysfunction ( p = 0.0144) and neuropathic pain ( p = 0.0030) compared with motor disorders. Conclusions. Our systematic review evidences that SCS is effective in MS patients. Urinary dysfunction and pain symptoms seem to be most responsive to SCS. Further studies are needed to improve the patient selection and clarify the best timing to perform SCS in these patients.

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“…We believe that the key to preventing recurrence is to accurately diagnose the type of TN before MVD. In addition to differences in clinical manifestations, magnetic resonance imaging technology, such as 3D T1-and T2-weighted high-resolution sequences and 3D timeof-flight MRA, can not only accurately show the neurovascular compression area and offending vessels but also diagnose TN alongside multiple sclerosis, a rare cause of the risk factors for atypical TN (16).…”

Section: Clinical Features Of Recurrent Trigeminal Neuralgiamentioning

confidence: 99%

Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia

Liu

Xiang

et al. 2020

Front. Neurol.

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Objective: To explore the clinical characteristics of patients with recurrent trigeminal neuralgia (TN) and the experience of microvascular decompression (MVD) in the treatment of such patients.Methods: We retrospectively analyzed clinical data, imaging examination results, surgical methods, and treatment efficacies in 127 patients with recurrent typical TN from January 2005 to December 2014.Results: The age of the recurrent group was higher than that of the non-recurrent group (p < 0.05). The duration of pain before the first MVD procedure was longer in the recurrent group than in the non-recurrent group (p < 0.05). Patients in the recurrent group were more likely to have compression of the trigeminal nerve by the vertebrobasilar artery (VBA) or multiple vessels than patients in the non-recurrent group (p < 0.05). A Kaplan–Meier curve showed a median pain-free survival of 12 months after the first MVD procedure. The severity of pain (preoperative visual analog scale [VAS] score) in patients with recurrence was lower than that in patients with first-onset TN (p < 0.05). Vessel compression, Teflon compression or granuloma and arachnoid adhesion were considered the main causes of recurrence. Postoperative Barrow Neurological Institute (BNI) scores in the redo MVD group were excellent (T = 2) for 69 patients (53.33%) and good (T = 3) for 46 patients (36.22%). The postoperative follow-up was 63–167 months (105.92 ± 25.66). During the follow-up, no recurrence was noted. All complications were cured or improved.Conclusions: Microvascular decompression (MVD) is an effective surgical method for the treatment of TN. For recurrent patients, reoperation can achieve good results.

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Microvascular decompression in patients with trigeminal neuralgia and multiple sclerosis: results and analysis of possible prognostic factors

Cited by 20 publications

References 32 publications

Trigeminal neuralgia: a practical guide

Trigeminal neuralgia: a practical guide

Is There a Place for Spinal Cord Stimulation in the Management of Patients with Multiple Sclerosis? A Systematic Review of the Literature

Long-Term Retrospective Analysis of Microvascular Decompression in Patients With Recurrent Trigeminal Neuralgia

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