Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to design a checklist with a scoring system for reporting on studies of surgical interventions for trigeminal neuralgia (TN) and to validate it by a review of the recent literature.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A checklist with a scoring system, the Surgical Trigeminal Neuralgia Score (STNS), was devised partially based on the validated STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and customized for TN after a literature review and then applied to a series of articles. These articles were identified using a prespecified MEDLINE and Embase search covering the period from 2008 to 2010. Of the 584 articles found, 59 were studies of interventional procedures for TN that fulfilled the inclusion criteria and 56 could be obtained in full. The STNS was then applied independently by 3 of the authors.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The maximum STNS came to 30, and was reliable and reproducible when used by the 3 authors who performed the scoring. The range of scores was 6–23.5, with a mean of 14 for all the journals. The impact factor scores of the journals in which the papers were published ranged from 0 to 4.8. Twenty-four of the studies were published in the <jats:italic>Journal of Neurosurgery</jats:italic> or in <jats:italic>Neurosurgery</jats:italic>. Studies published in neurosurgical journals ranked higher on the STNS scale than those published in nonneurosurgical journals. There was no statistically significant correlation between STNS and impact factors. Stereotactic radiosurgery (n = 25) and microvascular decompression (n = 15) were the most commonly reported procedures.</jats:p> <jats:p>The diagnostic criteria were stated in 35% of the studies, and 4 studies reported subtypes of TN. An increasing number of studies (46%) used the recommended Kaplan-Meier methodology for pain survival outcomes. The follow-up period was unclear in 8 studies, and 26 reported follow-ups of more than 5 years. Complications were reported fairly consistently but the temporal course was not always indicated. Direct interview, telephone conversation, and questionnaires were used to measure outcomes. Independent assessment of outcome was only clearly stated in 7 studies. Only 2 studies used the 36-Item Short Form Health Survey to measure quality of life and 4 studies reported on the severity of preoperative pain. The Barrow Neurological Institute pain questionnaire was the most commonly used outcome measure (n = 13), followed by the visual analog scale.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Similar to the STROBE criteria that provide a checklist of items that should be included in reports of observational studies in general, the authors' suggested checklist for the STNS could help editors and reviewers ensure that quality reports are published, and could prove useful for colleagues when reporting their results specifically on the surgical management of TN. It would help the patient and clinicians make a decision about selecting the appropriate neurosurgical procedure.</jats:p></jats:sec>

Trigeminal neuralgia

“…53 Furthermore, there is considerable variation in the quality of many cohort data studies. 54 According to large surgical series from multiple sites, microvascular decompression provides patients with about 80% chance of being pain-free without need for further treatment for trigeminal neuralgia, with a recurrence rate of about 10% over 10-20 years. 12 31 32 55-57 According to a systematic review for trigeminal neuralgia, the best surgical results in the short term (≤4 years) are achieved with microvascular decompression; the next best results come from the palliative destructive procedures, which have roughly equivalent results.…”

Advances in diagnosis and treatment of trigeminal neuralgia

“…On the other hand, percutaneous destructive procedures, involving a trans foramen ovale approach to the retrogasserian portion of the trigeminal nerve and gamma knife radiosurgery (GKRS) aiming at damaging the trigeminal nerve root with a high and concentrated dose of radiation, have been developed during the past years. While there is a wide literature about the surgical treatment of TN,67,68 the difficulty to evaluate the quality of published surgical reports is an emerging problem69 as recently evidenced by international guidelines and systematic reviews 67,70…”

Treatment of bilateral idiopathic trigeminal neuralgia by radiofrequency thermocoagulation at different temperatures

“…Different temperatures have been selected for RFT treatment of TN in various reports, [14,19,20] which may create confusion and misunderstanding among clinicians, and may cause clinicians to assume that only higher temperatures will yield better pain relief, in some cases inducing them to perform 10-minute RFT at temperatures of up to 95°C, with unavoidable occurrence of serious complications. In most studies, RFT is performed at 70°C to 95°C, and it is agreed that RFT is safe and effective for treatment of TN.…”

“…[5] There has been controversy in the recent literature regarding the suitable temperature for RFT in TN. [19,20] Temperatures ranging from 60°C to 95°C have been recommended, but excessive temperatures will unavoidably cause serious complications. Lack of standardization can easily lead to misunderstanding and confusion among clinicians.…”