Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Wu, Min; Jiang, Xiaofeng; Niu, Chaoshi; Fu, Xianming

doi:10.1159/000493547

Cited by 16 publications

(4 citation statements)

References 21 publications

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“…X.-F.J. and M.W. together, which had been published previously in detail by our team [15]. Both intraoperative findings and postoperative review of operative video were used to confirm the diagnosis of wNVC TN or woNVC TN prospectively.…”

Section: Mvd and Inmentioning

confidence: 99%

Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression

Jiang

Qiu

et al. 2020

J Headache Pain

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Purpose Previous researches have reported gray and white matter microalterations in primary trigeminal neuralgia (TN) with neurovascular compression (NVC). The central mechanism underlying TN without NVC are unknown but may include changes in specific brain regions or circuitries. This study aimed to investigate abnormalities in the gray matter (GM) and white matter (WM) of the whole brain and the possible pathogenetic mechanism underlying this disease. Methods We analyzed brain morphologic images of TN patients, 23 with NVC (TN wNVC) and 22 without NVC (TN wNVC) compared with 45 healthy controls (HC). All subjects underwent 3T-magnetic resonance imaging and pain scale evaluation. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) were used to investigate whole brain grey matter quantitatively; graph theory was applied to obtain network measures based on extracted DTI data based on DTI data of the whole brains. Sensory and affective pain rating indices were assessed using the visual analog scale (VAS) and short-form McGill Pain Questionnaire (SF-MPQ). Results The VBM and SBM analyses revealed widespread decreases in GM volume and cortical thickness in TN wNVC compared to TN woNVC, and diffusion metrics measures and topology organization changes revealed DTI showed extensive WM integrity alterations. However, above structural changes differed between TN wNVC and TN woNVC, and were related to specific chronic pain modulation mechanism. Conclusion Abnormalities in characteristic regions of GM and WM structural network were found in TN woNVC compared with TN wNVC group, suggesting differences in pathophysiology of two types of TN.

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Section: Mvd and Inmentioning

confidence: 99%

Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression

Jiang

Qiu

et al. 2020

J Headache Pain

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“…17,18 Also about 90% of patients suffered from facial numbness after MVD combined with internal neurolysis. [19][20][21] Complications could also impact the life quality of the patients. Zhang et al compared the effect and complications of redo MVD and percutaneous radiofrequency thermocoagulation for TN with failed MVD, the result showed that re-do MVD had better pain control and less complication.…”

Section: Discussionmentioning

confidence: 99%

Very early re-do microvascular decompression for patients with trigeminal neuralgia

Sun,

Su,

Wang

et al. 2024

NeuroAsia

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Although microvascular decompression (MVD) is the widely recognized surgical option for patient with trigeminal neuralgia (TN), and most patients could receive satisfactory outcome, some patients still complained of severe pain, with culprit vessel omission and incomplete decompression as the commonly mentioned reasons. Here we reported three cases of very early re-do MVD for patients with TN. We found that both artery and vein simultaneous compressed the trigeminal nerve, and tight adhesion was found between the vein and nerve. The artery was totally decompressed, but the vein could not be decompressed without affecting the blood flow due to the severe adhesion, the patients still complained of severe pain after the first surgery. Very early re-do MVD was performed and we totally separated the veins from the nerve. The symptoms of patients disappeared immediately without any complication. No recurrence was found during follow up. We conclude that culprit vein should be retained if possible, rather than sacrificed, and very early reoperation may be a feasible choice for patient with persistent symptom after MVD.

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“…The most common complication of MVD combined with IN is ipsilateral numbness [ 10 , 19 , 20 ]. Most of the patients in this group (88.6%) had different degrees of facial numbness on the surgical side after operation, which was much higher than that after MVD alone (10.3%) ( p <0.01).…”

Section: Discussionmentioning

confidence: 99%

Long Time Efficacy and Safety of Microvascular Decompression Combined with Internal Neurolysis for Recurrent Trigeminal Neuralgia

Zheng

Dong

Wang

et al. 2021

J Korean Neurosurg Soc

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Objective : To explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD. Methods : Sixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed. Results :The efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18-36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05). Conclusion :A retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of longterm facial numbness and other complications.

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Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Cited by 16 publications

References 21 publications

Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression

Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression

Very early re-do microvascular decompression for patients with trigeminal neuralgia

Long Time Efficacy and Safety of Microvascular Decompression Combined with Internal Neurolysis for Recurrent Trigeminal Neuralgia

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