Treatment of Trigeminal Neuralgia with “Microvascular Decompression Plus” Technique

Abstract

Objectives Although microvascular decompression (MVD) has been widely accepted as an effective treatment of trigeminal neuralgia (TN), some patients have not been cured. To improve the postoperative outcome, the surgical procedure should be further refined. Design This is a retrospective study. Setting Present study conducted at a cranial nerve disorder center. Participants: Clinical data were collected from patients with TN who had undergone surgery in our center, including 685 who had undergone traditional MVD and 576 who had undergone the “MVD plus” procedure, in which any vessel attached to the trigeminal nerve was freed away (“nerve-combing”), which was followed by intraoperative neurolysis. Main Outcome Measures Postoperative outcomes and complications in the two groups were compared. Results Among patients who underwent traditional MVD, the rates of immediate relief and 1-year relief were 89.9 and 86.9%, respectively; among patients who underwent MVD plus group, these rates were 95.1 and 94.6%, respectively (p = 0.05). Patients who underwent MVD plus initially exhibited a higher rate of facial numbness (p < 0.05), but this finding decreased over time and reached the same level as that in the traditional MVD group within 3 months (p > 0.05). Conclusion Sufficient MVD with nerve-combing for the treatment of TN may produce a high rate of cure with less recurrence.

The outcomes of microvascular decompression for primary trigeminal neuralgia: insights from a single-center experience and technical advancements

“…Following nerve decompression, we employ the “MVD Plus” Technique, which includes intraoperative neurolysis. Ming-Xing Liu's work demonstrates that combining sufficient microvascular decompression with nerve-combing for treating trigeminal neuralgia results in a high cure rate with fewer recurrences compared to microvascular decompression alone ( 21 ).…”

“…We placed an appropriately sized Teflon cotton ball between the implicated blood vessel and the trigeminal nerve root, establishing a barrier that effectively prevents any further compression or contact between them ( Figures 4C,D ). Following MVD ( Figures 5A,B ), we perform the additional combing technique, as described by Ming-Xing Liu ( 21 ), which has demonstrated better results in comparison to MVD alone ( Figures 5C,D ).…”