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DOI: 10.1055/s-0031-1284213
© Thieme Medical Publishers
Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia
Publication History
Publication Date:
31 August 2011 (online)
ABSTRACT
We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University Medical Centre Groningen/the Netherlands were evaluated. Baseline data from operative outcome were evaluated using univariate and multivariate analysis. The group consisted of 156 patients with TN: 90 females and 66 males with a median follow-up period of 9.7 years. The average age of initial symptoms was 51 years. The average duration of symptoms was 58 months. Postoperative 22 patients had a facial hyperpathia or hyperesthesia. Postoperatively, 137 patients had immediate relief. Postoperatively 1 year, 140 patients still had a good outcome of the operation. Twenty-seven patients with good immediate postoperative results had recurrent pain. From the group of patients with typical TN, 82% had good long-term results after operation. Patients with typical TN and immediate postoperative remission, in univariate analysis, had significantly more often an excellent/good postoperative outcome. Immediate postoperative remission is an independent predictive factor for a good long-term outcome. The long-term results of MVD in majority of patients were good with no mortalities and no major morbidities. Patients with typical TN had better long-term outcomes and less recurrence.
KEYWORDS
Microvascular decompression - trigeminal neuralgia - typical trigeminal neuralgia - Jannetta - long-term follow-up
REFERENCES
- 1 Dandy W E. Concering the cause of trigeminal neuralgia. Am J Surg. 1934; 24 447-455
- 2 Nurmikko T J, Eldridge P R. Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001; 87 (1) 117-132
- 3 Jannetta P J. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967; 26 (1) 159-162
- 4 Jannetta P J. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967; 26 (1) 159-162
- 5 Barker II F G, Jannetta P J, Bissonette D J, Larkins M V, Jho H D. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996; 334 (17) 1077-1083
- 6 Burchiel K J, Clarke H, Haglund M, Loeser J D. Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg. 1988; 69 (1) 35-38
- 7 Elias W J, Burchiel K J. Microvascular decompression. Clin J Pain. 2002; 18 (1) 35-41
- 8 Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery. 1997; 40 (1) 46-51 discussion 51-52
- 9 Resnick D K, Levy E I, Jannetta P J. Microvascular decompression for pediatric onset trigeminal neuralgia. Neurosurgery. 1998; 43 (4) 804-807 discussion 807-808
- 10 Kolluri S, Heros R C. Microvascular decompression for trigeminal neuralgia. A five-year follow-up study. Surg Neurol. 1984; 22 (3) 235-240
- 11 Li S T, Wang X, Pan Q et al.. Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. Clin J Pain. 2005; 21 (4) 311-316
- 12 Lee K H, Chang J W, Park Y G, Chung S S. Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia. Stereotact Funct Neurosurg. 1997; 68 (1-4 Pt 1) 196-199
- 13 Piatt Jr J H, Wilkins R H. Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery. 1984; 14 (4) 462-471
- 14 Slettebø H J, Eide P K. A prospective study of microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien). 1997; 139 (5) 421-425
- 15 Taarnhøj P. Decompression of the posterior trigeminal root in trigeminal neuralgia. A 30-year follow-up review. J Neurosurg. 1982; 57 (1) 14-17
- 16 Jannetta P J. Microsurgical management of trigeminal neuralgia. Arch Neurol. 1985; 42 (8) 800
- 17 White J C, Sweet W H. Pain and the Neurosurgeon. 1996; Springfield. III. Chales C. Thomas.
- 18 Bizzozero I, Ferrari F, Pozzoli S, Saetti M C, Spinnler H. Who is who: Italian norms for visual recognition and identification of celebrities. Neurol Sci. 2005; 26 (2) 95-107
- 19 Harris W. Rare forms of paroxysmal trigeminal neuralgia, and their relation to disseminated sclerosis. BMJ. 1950; 2 (4687) 1015-1019
- 20 Jensen T S, Rasmussen P, Reske-Nielsen E. Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features. Acta Neurol Scand. 1982; 65 (3) 182-189
- 21 Katusic S, Beard C M, Bergstralh E, Kurland L T. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990; 27 (1) 89-95
- 22 Rushton J G, Olafson R A. Trigeminal neuralgia associated with multiple sclerosis. A case report. Arch Neurol. 1965; 13 (4) 383-386
- 23 Clifford D B, Trotter J L. Pain in multiple sclerosis. Arch Neurol. 1984; 41 (12) 1270-1272
- 24 Hooge J P, Redekop W K. Trigeminal neuralgia in multiple sclerosis. Neurology. 1995; 45 (7) 1294-1296
- 25 Moulin D E, Foley K M, Ebers G C. Pain syndromes in multiple sclerosis. Neurology. 1988; 38 (12) 1830-1834
- 26 Stenager E, Knudsen L, Jensen K. Acute and chronic pain syndromes in multiple sclerosis. Acta Neurol Scand. 1991; 84 (3) 197-200
- 27 Rasmussen P. Facial pain. I. A prospective survey of 1052 patients with a view of: definition, delimitation, classification, general data, genetic factors, and previous diseases. Acta Neurochir (Wien). 1990; 107 (3-4) 112-120
- 28 Meaney J FM, Eldridge P R, Dunn L T, Nixon T E, Whitehouse G H, Miles J B. Demonstration of neurovascular compression in trigeminal neuralgia with magnetic resonance imaging. Comparison with surgical findings in 52 consecutive operative cases. J Neurosurg. 1995; 83 (5) 799-805
- 29 Hamlyn P J, King T T. Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg. 1992; 76 (6) 948-954
- 30 Namba S, Shimizu Y, Wani T, Fujiwara N. An experimental model of deafferented pain in the cat. Appl Neurophysiol. 1985; 48 (1-6) 201-211
- 31 Devor M, Seltzer Z. Pathophysiology of damaged nerves in relation to chronic pain. In: Wall P D, Melzack R, eds. Textbook of Pain. 4th ed. London: Churchill Livingstone; 1999: 129-164
- 32 Clavin W H, Howe J F, Loeser J D. Ectopic Repetitive Firing in Focally Demyelinated Axon and Some Implication for Trigeminal Region. Amsterdam: Elsevier/North-Holland; 1977: 125-136
- 33 Burchiel K J. Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg. 1980; 53 (5) 674-683
- 34 Lewy F H, Grant F C. Physiopathologic and pathoanatomic aspects of major trigeminal neuralgia. Arch Neurol Psychiatry. 1938; 40 1126-1134
- 35 Formm G H. Physiological rationale for the treatment of neuropathic pain. APS Journal. 1993; 2 1-7
- 36 Fromm G H, Chattha A S, Terrence C F, Glass J D. Role of inhibitory mechanisms in trigeminal neuralgia. Neurology. 1981; 31 (6) 683-687
- 37 Namba S, Shimizu Y, Wani T, Fujiwara N. An experimental model of deafferented pain in the cat. Appl Neurophysiol. 1985; 48 (1-6) 201-211
- 38 Love S, Coakham H B. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001; 124 (Pt 12) 2347-2360
- 39 Killian J M, Fromm G H. Carbamazepine in the treatment of neuralgia. Use of side effects. Arch Neurol. 1968; 19 (2) 129-136
- 40 Taylor J C, Brauer S, Espir M LE. Long-term treatment of trigeminal neuralgia with carbamazepine. Postgrad Med J. 1981; 57 (663) 16-18
- 41 Blom S. Trigeminal neuralgia: its treatment with a new anticonvulsant drug (G-32883). Lancet. 1962; 1 (7234) 839-840
- 42 Blom S. Trigeminal neuralgia: its treatment with a new anticonvulsant drug (G-32883). Lancet. 1962; 1 (7234) 839-840
- 43 Zakrzewska J M, Chaudhry Z, Nurmikko T J, Patton D W, Mullens E L. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. 1997; 73 (2) 223-230
- 44 Braham I, Saia A. Phenytoin in the treatment of trigeminal and other neuralgias. Lancet. 1960; 2 892-893
- 45 Campbell F G, Graham J G, Zilkha K J. Clinical trial of carbazepine (tegretol) in trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1966; 29 (3) 265-267
- 46 Nicol C F. A four year double-blind study of tegretol in facial pain. Headache. 1969; 9 (1) 54-57
- 47 Merren M D. Gabapentin for treatment of pain and tremor: a large case series. South Med J. 1998; 91 (8) 739-744
- 48 Valzania F, Strafella A P, Nassetti S A et al.. Gabapentin in idiopathic trigeminal neuralgia. Neurology. 1998; 50 A379 (abstract)
- 49 Apfelbaum R I. Surgical management of disorders of lower cranial nerve. In: Schmidek H H, Sweet W H, eds. Operative Neurosurgical Techniques. Indications, Methodes and Results. 2nd ed. Orlando: Grune & Stratton; 1988: 1097-1109
- 50 Bederson J B, Wilson C B. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg. 1989; 71 (3) 359-367
- 51 Burchiel K J, Steege T D, Howe J F, Loeser J D. Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux. Neurosurgery. 1981; 9 (2) 111-119
- 52 Goya T, Wakisaka S, Kinoshita K. Microvascular decompression for trigeminal neuralgia with special reference to delayed recurrence. Neurol Med Chir (Tokyo). 1990; 30 (7) 462-467
- 53 Jannetta P J. Microvascular decompression of the trigeminal nerve root entry zone. Theoretical considerations, operative anatomy, surgical technique, and results. In: Rovit R L, Murali R, Jannetta P J, eds. Trigeminal Neuralgia. Baltimore: Williams & Wilkins; 1990: 201-222
- 54 Klun B. Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery. 1992; 30 (1) 49-52
- 55 Mori K, Morimoto M, Kurisaka M, Uchida Y, Eghwrudjakpor P. Analysis of microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm. Nippon Geka Hokan. 1986; 55 (6) 768-776
- 56 Richards P, Shawdon H, Illingworth R. Operative findings on microsurgical exploration of the cerebello-pontine angle in trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1983; 46 (12) 1098-1101
- 57 Sindou M, Amrani F, Mertens P. [Microsurgical vascular decompression in trigeminal neuralgia. Comparison of 2 technical modalities and physiopathologic deductions. A study of 120 cases]. Neurochirurgie. 1990; 36 (1) 16-25 discussion 25-26
- 58 van Loveren H, Tew Jr J M, Keller J T, Nurre M A. a 10-year experience in the treatment of trigeminal neuralgia. Comparison of percutaneous stereotaxic rhizotomy and posterior fossa exploration. J Neurosurg. 1982; 57 (6) 757-764
- 59 Apfelbaum R. Neurovascular decompression: the procedure of choice?. In: Grady S, ed. Clinical Neurosurgery. Vol 46, Baltimore: Lippincott Williams & Wilkins; 1998: 473-498
- 60 McLaughlin M R, Jannetta P J, Clyde B L, Subach B R, Comey C H, Resnick D K. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg. 1999; 90 (1) 1-8
- 61 Barker II F G, Jannetta P J, Bissonette D J, Jho H D. Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia. Neurosurgery. 1997; 40 (1) 39-45
- 62 Jannetta P J. Microsurgical approach to the trigeminal nerve of tic douloureux. Prog Neurol Surg. 1976; 7 180-200
- 63 Jannetta P J. Neurovascular compression in cranial nerve and systemic disease. Ann Surg. 1980; 192 (4) 518-525
- 64 Young R F, Vermeulen S S, Grimm P, Blasko J, Posewitz A. Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related. Neurology. 1997; 48 (3) 608-614
- 65 Cox D R. Regression models and life tables. J R Stat Soc [Ser B]. 1972; 34 187-220
- 66 Mendoza N, Illingworth R D. Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study. Br J Neurosurg. 1995; 9 (1) 13-19
- 67 Lovely T J, Jannetta P J. Microvascular decompression for trigeminal neuralgia. Surgical technique and long-term results. Neurosurg Clin N Am. 1997; 8 (1) 11-29
- 68 Barba D, Alksne J F. Success of microvascular decompression with and without prior surgical therapy for trigeminal neuralgia. J Neurosurg. 1984; 60 (1) 104-107
- 69 Apfelbaum R I. Surgery for tic douloureux. Clin Neurosurg. 1983; 31 351-368
- 70 Puca A, Meglio M, Cioni B, Visocchi M, Vari R. Microvascular decompression for trigeminal neuralgia: prognostic factors. Acta Neurochir Suppl (Wien). 1993; 58 165-167
- 71 Szapiro Jr J JR, Sindou M, Szapiro J. Prognostic factors in microvascular decompression for trigeminal neuralgia. Neurosurgery. 1985; 17 (6) 920-929
- 72 Barker II F G, Jannetta P J, Bissonette D J, Larkins M V, Jho H D. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996; 334 (17) 1077-1083
Chenur OesmanM.Sc.
King's College Hospital
London, UK
Email: chenuroesman@nhs.net