Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 221-227
DOI: 10.1055/s-0044-1779516
Research Article

Microvascular Decompression versus Radiofrequency Ablation in Trigeminal Neuralgia of the Maxillary and Mandibular Divisions

Hosam-Eldin Abdel-Azim Habib 
1   Neurosurgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
,
Mohamed Hamdy Ellakany
2   Anesthesia and Pain Management Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
,
Hossam Elnoamany
1   Neurosurgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
,
Ahmed Gabry Elnaggar
1   Neurosurgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Although medical treatment is the mainstay of therapy, in trigeminal neuralgia (TN), patients failing to respond to it make them candidates to ablative or nonablative procedures.

Objective The aim of this study was to compare the outcome of Microvascular decompression (MVD) and radiofrequency (RF) thermocoagulation in the management of TN affecting the mandibular and maxillary divisions.

Materials and Methods Retrospective analysis of the data of 40 patients suffering from intractable classical TN affecting the maxillary or mandibular divisions or both was carried out. Twenty patients were operated upon by MVD of the trigeminal nerve; and 20 had RF ablation of the maxillary or mandibular divisions of the trigeminal nerve or both.

Results In MVD the overall successful outcome was achieved in 16 patients (80%), while the failure was in 4 patients (20%) of which 3 had a fair outcome and 1 patient had a poor outcome. Whereas in RF the overall successful outcome was achieved in 17 patients (85%), while the failure was in 3 patients (15%) of which 2 had a fair outcome and 1 patient had a poor outcome. Outcome was insignificantly different between both groups (p-value 0.806).

Conclusion MVD and RF ablation represent safe and efficacious surgical choices for addressing TN that encompasses both the mandibular and maxillary divisions. Long-term follow-up studies demonstrate that MVD consistently yields favorable outcomes, establishing it as the preferred primary surgical technique, unless contraindicated by the patient's general health and specific needs.

Keywords

trigeminal - neuralgia - microvascular - decompression - radiofrequency

Ethical Approval

The study was approved by the Local Ethical Scientific Committee of the Menoufia Faculty of Medicine, Menoufia, Egypt. The Institutional Review Board (IRB) approval number and date ID: 4/2023NEUS14-2.


Authors' Contributions

All authors contributed equally.




Publication History

Article published online:
27 May 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Apfelbaum RI. Comparison of the long-term results of microvascular decompression and percutaneous trigeminal neurolysis for the treatment of trigeminal neuralgia. Int Congr Ser 2002; 1247: 629-643
    CrossrefGoogle Scholar
  • 2 Salama H, Ben-Khayal H, Mohamed MA. et al. Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia. Ann Indian Acad Neurol 2009; 12 (03) 173-178
    CrossrefPubMedGoogle Scholar
  • 3 Cohen-Gadol AA. Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm: naunces of the technique based on experiences with 100 patients and review of the literature. Clin Neurol Neurosurg 2011; 113 (10) 844-853
    CrossrefPubMedGoogle Scholar
  • 4 Møller AR. Vascular compression of cranial nerves: II: pathophysiology. Neurol Res 1999; 21 (05) 439-443
    CrossrefPubMedGoogle Scholar
  • 5 Thomas KL, Vilensky JA. The anatomy of vascular compression in trigeminal neuralgia. Clin Anat 2014; 27 (01) 89-93
    CrossrefPubMedGoogle Scholar
  • 6 Spatz AL, Zakrzewska JM, Kay EJ. Decision analysis of medical and surgical treatments for trigeminal neuralgia: how patient evaluations of benefits and risks affect the utility of treatment decisions. Pain 2007; 131 (03) 302-310
    CrossrefPubMedGoogle Scholar
  • 7 Park YS, Kim JP, Chang WS, Kim HY, Park YG, Chang JW. Gamma knife radiosurgery for idiopathic trigeminal neuralgia as primary vs. secondary treatment option. Clin Neurol Neurosurg 2011; 113 (06) 447-452
    CrossrefPubMedGoogle Scholar
  • 8 Keric N, Kalasauskas D, Kreth SL. et al. An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia. BMC Neurol 2021; 21 (01) 182
    CrossrefPubMedGoogle Scholar
  • 9 Li Y, Yang L, Ni J, Dou Z. Microvascular decompression and radiofrequency for the treatment of trigeminal neuralgia: a meta-analysis. J Pain Res 2019; 12: 1937-1945
    CrossrefPubMedGoogle Scholar
  • 10 Håkanson S. Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 1981; 9 (06) 638-646
    CrossrefPubMedGoogle Scholar
  • 11 Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia. J Neurosurg 1974; 40 (02) 143-156
    CrossrefPubMedGoogle Scholar
  • 12 Fujiwara S, Sasaki M, Wada T. et al. High-resolution diffusion tensor imaging for the detection of diffusion abnormalities in the trigeminal nerves of patients with trigeminal neuralgia caused by neurovascular compression. J Neuroimaging 2011; 21 (02) e102-e108
    CrossrefPubMedGoogle Scholar
  • 13 Jo KW, Kong DS, Hong KS, Lee JA, Park K. Long-term prognostic factors for microvascular decompression for trigeminal neuralgia. J Clin Neurosci 2013; 20 (03) 440-445
    CrossrefPubMedGoogle Scholar
  • 14 Sindou M, Leston J, Howeidy T, Decullier E, Chapuis F. Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien) 2006; 148 (12) 1235-1245
    CrossrefPubMedGoogle Scholar
  • 15 Leal PR, Hermier M, Souza MA, Cristino-Filho G, Froment JC, Sindou M. Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery 2011; 69 (01) 15-25
    CrossrefPubMedGoogle Scholar
  • 16 Blitz AM, Northcutt B, Shin J. et al. Contrast-enhanced CISS imaging for evaluation of neurovascular compression in trigeminal neuralgia: improved correlation with symptoms and prediction of surgical outcomes. AJNR Am J Neuroradiol 2018; 39 (09) 1724-1732
    CrossrefPubMedGoogle Scholar
  • 17 Zhang H, Lei D, You C, Mao BY, Wu B, Fang Y. The long-term outcome predictors of pure microvascular decompression for primary trigeminal neuralgia. World Neurosurg 2013; 79 (5-6): 756-762
    CrossrefPubMedGoogle Scholar
  • 18 Leal PR, Barbier C, Hermier M, Souza MA, Cristino-Filho G, Sindou M. Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. J Neurosurg 2014; 120 (06) 1484-1495
    CrossrefPubMedGoogle Scholar
  • 19 Laghmari M, El Ouahabi A, Arkha Y, Derraz S, El Khamlichi A. Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia?. Surg Neurol 2007; 68 (05) 505-512
    CrossrefPubMedGoogle Scholar
  • 20 Zakrzewska JM. Surgery for trigeminal neuralgia?. Pain 2011; 152 (03) 469-470
    CrossrefPubMedGoogle Scholar
  • 21 Hong T, Ding Y, Yao P. Long-term efficacy and complications of radiofrequency thermocoagulation at different temperatures for the treatment of trigeminal neuralgia. Biochem Res Int 2020; 2020: 3854284
    CrossrefPubMedGoogle Scholar
  • 22 Tronnier VM, Rasche D, Hamer J, Kienle AL, Kunze S. Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 2001; 48 (06) 1261-1267
    PubMedGoogle Scholar
  • 23 Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 2008; 150 (03) 243-255
    CrossrefPubMedGoogle Scholar
  • 24 Herta J, Loidl TB, Schmied T. et al. Retrospective comparison of percutaneous balloon compression and radiofrequency-thermocoagulation in the management of trigeminal neuralgia. Acta Neurochir (Wien) 2023; 165 (07) 1943-1954
    PubMedGoogle Scholar
  • 25 Liu G, Du Y, Wang X, Ren Y. Efficacy and safety of repeated percutaneous radiofrequency thermocoagulation for recurrent trigeminal neuralgia. Front Neurol 2019; 9: 1189
    CrossrefPubMedGoogle Scholar
  • 26 Bharti N, Sujith J, Singla N, Panda NB, Bala I. Radiofrequency thermoablation of the Gasserian ganglion versus the peripheral branches of the trigeminal nerve for treatment of trigeminal neuralgia: a randomized. Pain Physician 2019; 22 (02) 147-154
    CrossrefPubMedGoogle Scholar
  • 27 Zhao W, Yang L, Deng A, Chen Z, He L. Long-term outcomes and predictors of percutaneous radiofrequency thermocoagulation of Gasserian ganglion for maxillary trigeminal neuralgia: a retrospective analysis of 1070 patients with minimum 2-year follow-up. Ann Med 2022; 54 (01) 2420-2430
    CrossrefPubMedGoogle Scholar
  • 28 Sekula Jr RF, Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD. Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis. J Neurosurg 2011; 114 (01) 172-179
    CrossrefPubMedGoogle Scholar
  • 29 Toda K. Operative treatment of trigeminal neuralgia: review of current techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106 (06) 788-805 , 805.e1–805.e6
    CrossrefPubMedGoogle Scholar
  • 30 Broggi G, Ferroli P, Franzini A. Treatment strategy for trigeminal neuralgia: a thirty years experience. Neurol Sci 2008; 29 (Suppl. 01) S79-S82
    CrossrefPubMedGoogle Scholar
  • 31 Texakalidis P, Xenos D, Tora MS, Wetzel JS, Boulis NM. Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. Clin Neurol Neurosurg 2019; 182: 112-122
    CrossrefPubMedGoogle Scholar
  • 32 Yao P, Deng YY, Hong T. et al. Radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia: effect of treatment temperatures on long-term clinical outcomes: a cohort study. Medicine (Baltimore) 2016; 95 (26) e4019
    CrossrefPubMedGoogle Scholar
  • 33 Huang Q, Liu X, Chen J. et al. The effectiveness and safety of thermocoagulation radiofrequency treatment of the ophthalmic division (V1) and/or maxillary (V2) and mandibular (V3) division in idiopathic trigeminal neuralgia: an observational study. Pain Physician 2016; 19 (07) E1041-E1047
    PubMedGoogle Scholar
  • 34 Tang YZ, Jin D, Bian JJ, Li XY, Lai GH, Ni JX. Long-term outcome of computed tomography-guided percutaneous radiofrequency thermocoagulation for classic trigeminal neuralgia patients older than 70 years. J Craniofac Surg 2014; 25 (04) 1292-1295
    CrossrefPubMedGoogle Scholar
  • 35 Sarnvivad P, Bumpenboon A, Chumnanvej S. Retrospective long term outcome following microvascular decompression surgery in Thai patients with trigeminal neuralgia. J Med Assoc Thai 2013; 96 (07) 801-806
    PubMedGoogle Scholar
  • 36 Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol 2021; 21 (05) 392-402
    CrossrefPubMedGoogle Scholar
  • 37 Abduhamid AS, Alomari MS, Ghaddaf AA. et al. Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: a systematic review and meta-analysis. J Clin Neurosci 2022; 104: 42-47
    CrossrefPubMedGoogle Scholar