Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis

Berger, Ian; Nayak, Natasha V.; Schuster, James M.; Lee, John; Stein, Sherman C.; Malhotra, Neil R.

doi:10.7759/cureus.1000

Cited by 14 publications

(10 citation statements)

References 106 publications

(59 reference statements)

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“…Patient was treated by trigeminal nerve block. Our results of MVD for HFS & TN were comparable with other studies 20,21 .…”

Section: Resultssupporting

confidence: 91%

“…An analysis of twenty-two papers representing 5,685 patients treated with MVD for HFS found that an average of 91.1% of patients had complete resolution of symptoms over a median 2.9year follow-up period 20 . Another metaanalysis included 8,484 cases of TN who underwent either MVD or gamma knife and concluded that MVD is better than GKRS in treating patients with idiopathic TN, better outcomes in the MVD group is because of immediate post op pain relief&MVD should be offered as first line of surgical intervention if no contraindication for surgery 21 . However there are reports that even despite of good microvascular decompression there are instances of no pain relief.…”

Section: Introductionmentioning

confidence: 99%

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Computational Fluid Dynamics as an Indicator of Offending Vessel in Trigeminal Neuralgia and Hemifacial Spasms

Kamath¹,

Yamada²,

Kato³

2018

Romanian Neurosurgery

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Context: Newer Imaging tool for diagnosing offending vessel in trigeminal neuralgia (TN) and Hemifacial spasms (HFS). Aim: To find out if Computational FluidDynamics (CFD) can correctly predict the offending vessel in HFS and TN & thus improving the outcome of Microvascular Decompression) MVD. Settings and Design: CFD is a relatively new mode of imaging. Its application to indicate offending vessel in TN & HFS was tested. Materials & Methods: Retrospectively we studied 13 consecutive patients operated in 2017 for either HFS or TN. Preoperatively MRI & Computed Tomography Angiogram (CTA) were done and the offending vessel identified along with its point of contact with the concerned nerve. CFD was done using Hemoscope 2015 software and wall pressure, wall shear stress, vector & streamline flow were obtained in the offending vessel (test) & contralateral vessel (control). Results of these were charted on an excel sheet & results analyzed. The postoperativeoutcome were assessed and compared with CFD results. Statistical analysis used: Small study group hence statistical analysis couldn’t be applied. Results: Of the 13 patients, offending artery had high wall pressure in 12 and increased wall shear stress innine. Among the controls six had high wall pressure and only two had high wall shear stress. Conclusion: CFD can be used to determine offending vessel and can predict good outcome following microvascular decompression.

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“…Patient was treated by trigeminal nerve block. Our results of MVD for HFS & TN were comparable with other studies 20,21 .…”

Section: Resultssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Computational Fluid Dynamics as an Indicator of Offending Vessel in Trigeminal Neuralgia and Hemifacial Spasms

Kamath¹,

Yamada²,

Kato³

2018

Romanian Neurosurgery

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“…Although increasing the dose can improve efficacy, it simultaneously increases the risk of facial numbness (28). MVD is one of the most effective therapeutic methods for TN patients (29)(30)(31)(32). However, it will be ineffective without neurovascular compression (NVC).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of High-Voltage Pulsed Radiofrequency to Treat Patients with Primary Trigeminal Neuralgia: A Multicenter, Randomized, Double-Blind, Controlled Study Protocol

et al. 2018

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Background: Trigeminal neuralgia (TN) is a neurological syndrome characterized by paroxysmal, lightning-like, severe pain in the facial area innervated by the trigeminal nerve. Patients who do not respond well to drug treatment can undergo a nerve block, a traditional conservative treatment. Pulsed radiofrequency (PRF) is a nondestructive pain intervention technique. However, its treatment effectiveness for TN has rarely been reported and remains controversial among scholars. A recent single-center preliminary clinical study showed that high-voltage PRF was significantly effective in the treatment of TN. However, whether high-voltage PRF is a viable pain treatment option for TN patients who are unresponsive to drug treatment must still be confirmed with standardized clinical studies by utilizing conservative nerve block treatment as a control. Objective: To compare theeffectiveness and safety of high-voltage PRF and nerve block for primary TN patients who have failed to respond topharmacological treatment and who are seeking a better non-surgical treatment option. Study Design: Prospective, multicenter, randomized, double-blind, controlled clinical trial. Setting: Three interventional pain management centers in Beijing, China. Methods: The study will include 134 consecutive patients with primary TN who have failed to respond to drug treatment. The patients will be randomly assigned to 2 groups, the nerve block group and the PRF group. The nerve block group will be slowly injected with 1.4 mL of a mixture of dexamethasone and lidocaine after 360 s of sham PRF treatment, and 0.5 mL of normal saline will be administered before the needle is withdrawn. The PRF group will undergo 360 s of 42°C PRF treatment at the highest output voltage that the patients can tolerate, after which the patients will be injected with the same concentration and volume of lidocaine and normal saline that the nerve block group receives. The Barrow Neurological Institute (BNI) pain intensity scale will be used to assess the degree of pain relief before and after the treatment. Results: The effectiveness and safety of high-voltage PRF and nerve block to treat TN will be analyzed to determine significant differences in pain relief and functional improvement. The primary efficacy outcome measure is the response rate at one-year post-operation (BNI I-III/total number of cases*100%). Secondary efficacy outcome measures include the response rate at postoperative day 1, week 1, week 2, month 1, month 3, month 6 and year 2, the patient satisfaction score (PSS) at various time points, the dosage of antiepileptic drugs (milligrams per day), and information regarding patients with a BNI score of IV or V who switch to other therapies. Limitations: The effects of the waveform, treatment duration, frequency and other parameters of PRF deserve further investigation. Conclusions: This is the first multicenter, double-blind, randomized controlled study to compare the efficacy and safety of PRF and nerve block to treat TN patients who have failed to respond to drug treatment. Moreover, the value of PRF in TN treatment may need to be clinically clarified with evidence-based medical support and other advanced studies. Key words: Trigeminal neuralgia, effectiveness, safety, pulsed radiofrequency

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“…Quality‐of‐life measures are significantly worse for rhizotomy patients compared with MVD patients 5 years after treatment . Quality of life at 7‐year follow‐up is significantly better than with radiosurgery …”

Section: Introductionmentioning

confidence: 97%

Nationwide Shift From Percutaneous Rhizotomy to Microvascular Decompression for Treatment of Trigeminal and Other Cranial Nerve Neuralgias

Kundu

Rolston

2018

Headache

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Objective The aim of this study was to report the trends in the use of common surgical interventions over the past decade to treat cranial nerve neuralgias. Methods The Centers for Medicare and Medicaid Services Part B National Summary Data File from 2000 to 2016 were studied. Results A total of 57.1 million persons were enrolled in 2016, up from 39.6 million persons in 2000. Suboccipital craniectomy done for cranial nerve decompressions (including cranial nerves V, VII, and IX) increased by 33.9 cases per year so that in 2016 the number of cases was 167% of what it was 17 years earlier (ie, from 655 cases in 2000 to 1096 cases in 2016). The less commonly used subtemporal approach craniectomy to treat trigeminal neuralgia (TN) increased by 1.13 cases per year (ie, from 25 cases in 2000 to 46 cases in 2016). The less invasive percutaneous rhizotomy procedures, including glycerol and radiofrequency ablation, for treatment of TN decreased by 42.9 cases per year (64%; ie, from 2578 cases in 2000 to 1206 cases in 2016). Conclusions Overall trends show increased use of open surgery and decreased use of percutaneous rhizotomy, including destruction of the trigeminal nerve using balloon compression, glycerol injection, or thermal injury. These trends may be related to differences in outcomes between treatment modalities.

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Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Decision Analysis

Cited by 14 publications

References 106 publications

Computational Fluid Dynamics as an Indicator of Offending Vessel in Trigeminal Neuralgia and Hemifacial Spasms

Computational Fluid Dynamics as an Indicator of Offending Vessel in Trigeminal Neuralgia and Hemifacial Spasms

Effectiveness and Safety of High-Voltage Pulsed Radiofrequency to Treat Patients with Primary Trigeminal Neuralgia: A Multicenter, Randomized, Double-Blind, Controlled Study Protocol

Nationwide Shift From Percutaneous Rhizotomy to Microvascular Decompression for Treatment of Trigeminal and Other Cranial Nerve Neuralgias

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