Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia

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