Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study

Abstract

Background: About 50% of patients that suffer from trigeminal neuralgia do not experience sustained benefit from the use of oral medication. For their adequate management, a few surgical procedures are available. Of these, percutaneous balloon compression (PBC) and microvascular decompression (MD) are two of the most performed worldwide. In this retrospective study, we present the outcomes of these techniques through estimation of initial pain relief and subsequent recurrence rate. Methods: Thirty-seven patients with medically refractory trigeminal pain surgically treated at Hospital Cajuru, Curitiba, Brazil, with PBC, MD or both between 2013 and 2018 were enrolled into this retrospective study. The post-procedural rate for pain relief and recurrence and associations between patient demographics and outcomes were analyzed. Results: MD had an earlier recurrence time than balloon compression. Of the 37 patients, the mean age was 61.6 years, approximately one third were male and most had type I neuralgia. The most affected branch was the maxillary (V2). The time for recurrence after surgery was on average 11.8 months for PBC and 9.0 months for MD. Complications were seen only with microsurgery. Conclusions: MD presented with a more precocious recurrence of pain than PBC in this article. Moreover, it had a higher recurrence rate than described in the literature as well, which is possibly explained by the type of graft (muscle) that was used to separate the neurovascular structures.

Clinical Analysis of the Treatment of Primary Trigeminal Neuralgia by Percutaneous Balloon Compression

“…The rate of postoperative pain relief in PBC was 88.9–97.3%, and the rate of complete pain relief was about 62% in more than 10 years of follow-up. PBC also has a good curative effect on recurrent trigeminal neuralgia after microvascular decompression, the complete pain relief rate reached 82.7% in 3 years after operation ( 14 ). The effective relief rate of postoperative pain in this study was 92.3%, which was similar to previous reports and equivalent to the therapeutic effect of MVD.…”

Terapias farmacológicas para a neuralgia do trigêmeo: revisão de literatura

“…O nervo trigêmeo é o quinto nervo craniano (NC V) e possui 3 ramificações: oftálmico, maxilar e mandibular [1][2][3] . É considerado um nervo de função mista, com fibras sensitivas e motoras 1 , com predomínio de funções sensitivas 2 .…”

“…Os três ramos são responsáveis pela sensibilidade somática da face 2 . O ramo oftálmico (V1) é um ramo sensitivo 3,4 , que inerva o terço superior da face 1,3,4 . O nervo maxilar (V2), por sua vez, inerva o terço médio 1 , atuando também como nervo sensitivo 4 .…”

“…O nervo maxilar (V2), por sua vez, inerva o terço médio 1 , atuando também como nervo sensitivo 4 . A porção motora do trigêmeo corresponde ao ramo mandibular [2][3][4] . Esse ramo é responsável por inervar os músculos que participam da mastigação 1,2,4 , mas também tem funções sensitivas, assim como os outros 4 .…”

“…A NT pode se manifestar de maneira puramente paroxística, ou seja, sem dor contínua 3 ; ou ainda com dor facial concomitante e persistente 4,5,7 . É caracterizada por episódios de dor unilateral, na grande maioria dos casos 8 , descritas como agudas 5,7 .…”