Microvascular Decompression versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Experience

Li, Luyuan; Seaman, Scott C.; Bathla, Girish; Smith, Mark C.; Dundar, Bilge; Noeller, Jennifer; Hitchon, Patrick W.

doi:10.1016/j.wneu.2020.07.161

Cited by 13 publications

(3 citation statements)

References 21 publications

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“…[ 23 ] Careful preoperative comorbidity and frailty assessment[ 23 ] are necessary. Some studies reported that MVD could provide better long-term pain relief and less facial sensory complication than gamma knife[ 13 , 14 , 31 , 38 ] and rhizotomy. [ 10 , 16 ] A single study demonstrated that complication-related HRQoL was more common in patients treated with rhizotomy than MVD.…”

Section: Discussionmentioning

confidence: 99%

Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older

Yoshizaki

Fujikawa

Torikoshi

et al. 2023

Surgical Neurology International

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Background: Trigeminal neuralgia (TN) occasionally affects older adults, frequently worsens, and becomes refractory to medication. Older adult patients with TN may consider microvascular decompression (MVD) for their treatment. No study examines MVD effects on older adult TN patients’ health-related quality of life (HRQoL). The present study evaluates the HRQoL of TN patients aged 70 years and older before and after MVD. Methods: Adult TN patients who underwent MVD evaluated their HRQoL using the 36-Item Short-form (SF-36) Health Survey before and 6 months after MVD. The patients were divided into four groups according to their decade of age. The clinical parameters and operative outcomes were analyzed statistically. The SF-36 physical, mental, and role social component summary scores and eight domain scale scores were analyzed using a twoway repeated-measures analysis of variance (ANOVA) to compare the effects of age group and preoperative and postoperative time points. Results: Among 57 adult patients (34 women, 23 men; mean age, 69 years; range, 30–89 years), 21 patients were in their seventies, and 11 were in their eighties. The SF-36 scores of patients in all age groups improved after MVD. Two-way repeated-measures ANOVA demonstrated a significant age group effect on the physical component summary and its physical functioning domain. A time point effect was significant on all component summaries and domains. There was a significant interaction between age group and time point effects on the bodily pain domain. These results suggested that patients 70 years and older had significant postoperative HRQoL improvement, but their improvement of physical-related HRQoL and multiple physical pain issues were limited. Conclusion: Impaired HRQoL in TN patients aged 70 years and older can improve after MVD. Careful management of multiple comorbidities and surgical risks enables MVD to be an appropriate treatment for older adult patients with refractory TN.

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Section: Discussionmentioning

confidence: 99%

Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older

Yoshizaki

Fujikawa

Torikoshi

et al. 2023

Surgical Neurology International

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“…[ 1 , 19 ] SRS, a less invasive procedure that lacks the surgical risks of MVD (facial numbness/palsy, cerebrospinal fluid leaks, hearing deficits, and incisional infections), may be offered to older patients who are poor surgical candidates due to comorbidities. [ 10 , 17 , 19 , 24 ] When evaluated retrospectively, MVD has been reported to be superior to SRS with a significantly higher health-related quality of life, higher initial cure rate, lower rate of recurrence and complications, complete pain relief, durability of response, and preservation of trigeminal sensation. [ 17 , 33 ] However, most patients who undergo SRS are either not candidates for MVD or have recurrent pain after MVD, usually several years later.…”

Section: Introductionmentioning

confidence: 99%

“…[ 10 , 17 , 19 , 24 ] When evaluated retrospectively, MVD has been reported to be superior to SRS with a significantly higher health-related quality of life, higher initial cure rate, lower rate of recurrence and complications, complete pain relief, durability of response, and preservation of trigeminal sensation. [ 17 , 33 ] However, most patients who undergo SRS are either not candidates for MVD or have recurrent pain after MVD, usually several years later. Pain relief from SRS is related to the radiation dose delivered to the postganglionic intracranial nerve, with increased rates of pain relief with higher doses (usually between 80 and 90 Gy).…”

Section: Introductionmentioning

confidence: 99%

Frameless image-guided linear accelerator (LINAC) stereotactic radiosurgery for medically refractory trigeminal neuralgia: Clinical outcomes in 116 patients

Shields,

Malkawi,

Daniels

et al. 2024

Surgical Neurology International

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Background: Frameless image-guided radiosurgery (IGRS) is an effective and non-invasive method of treating patients who are unresponsive to medical management for trigeminal neuralgia (TN). This study evaluated the use of frameless IGRS to treat patients with medically refractory TN. Methods: We performed a retrospective review of records of 116 patients diagnosed with TN who underwent frameless IGRS using a linear accelerator (LINAC) over 10 years (March 2012-February 2023). All patients had failed medical management for TN. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. Each patient received a BNI score before frameless IGRS and following treatment. Failure was defined as a BNI score IV-V at the last follow-up and/or undergoing a salvage procedure following IGRS. Results: All patients had a BNI score of either IV or V before the frameless IGRS. The mean follow-up duration for all 116 patients following IGRS was 44.1 months. Most patients (81 [69.8%]) had not undergone surgery (microvascular decompression [MVD] or rhizotomy) or stereotactic radiosurgery (SRS) for TN before frameless IGRS. A total of 41 (35.3%) patients underwent a salvage procedure (MVD, rhizotomy, or an additional IGRS) following frameless IGRS. The mean duration between the initial frameless IGRS and salvage procedure was 20.1 months. At the last follow-up, a total of 110 (94.8%) patients had a BNI score of I-III. No complications were reported after the frameless IGRS. The BNI score at the last follow-up was lower compared to the initial BNI for patients regardless of prior intervention (P < 0.001). Patients who failed IGRS had a higher BNI score at the last follow-up compared to those who did not fail IGRS (2.8 vs. 2.5, P = 0.05). Patients with pain relief had a shorter follow-up compared to those with pain refractory to SRS (38.0 vs. 55.1, P = 0.005). Conclusion: In this large cohort of patients with medically refractory TN, frameless IGRS resulted in durable pain control in the majority of patients without any toxicity.

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Operative Complications of Microvascular Decompression for Trigeminal Neuralgia

Lee

2023

Trigeminal Neuralgia

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Microvascular Decompression versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Experience

Cited by 13 publications

References 21 publications

Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older

Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older

Frameless image-guided linear accelerator (LINAC) stereotactic radiosurgery for medically refractory trigeminal neuralgia: Clinical outcomes in 116 patients

Operative Complications of Microvascular Decompression for Trigeminal Neuralgia

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