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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(01): 51-55
DOI: 10.1590/0004-282X-anp-2020-0115
ARTICLE

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

Neuralgia do trigêmeo recorrente: uma comparação entre descompressão microvascular e compressão percutânea por balão: um estudo de acompanhamento de cinco anos
Jennyfer Paulla Galdino CHAVES 
1   Hospital Universitário Cajuru, Curitiba PR, Brazil.
,
Tatiana Von Hertwig Fernandes DE OLIVEIRA 
1   Hospital Universitário Cajuru, Curitiba PR, Brazil.
,
Alexandre Novick FRANCISCO 
1   Hospital Universitário Cajuru, Curitiba PR, Brazil.
,
Mariana de Oliveira TRINTINALHA 
2   Universidade Positivo, Curitiba PR, Brazil.
,
Niels Vinicius Pádua CARVALHO 
2   Universidade Positivo, Curitiba PR, Brazil.
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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.

RESUMO

Introdução: Cerca de 50% dos pacientes com neuralgia do trigêmeo não apresenta benefícios a longo prazo com o uso de medicação oral. Para a manutenção do tratamento, algumas opções cirúrgicas estão disponíveis, sendo a compressão percutânea por balão (CPB) e a descompressão microvascular (DM) algumas das modalidades mais realizadas em todo o mundo. Neste estudo retrospectivo, apresentamos os desfechos dessas técnicas por meio de estimativa da melhora inicial da dor e da taxa de recorrência subsequente. Métodos: Trinta e sete pacientes com dor trigeminal refratária ao tratamento medicamentoso tratados cirurgicamente no Hospital Cajuru, Curitiba, Brasil, com CPB, DM ou ambos entre 2013 e 2018 foram incluídos neste estudo retrospectivo. A taxa pós-procedimento para alívio e recorrência da dor e suas associações com a demografia e desfechos dos pacientes foram analisadas. Resultados: A DM foi associada a menor recorrência que a compressão por balão. Entre os 37 pacientes, a idade média foi de 61,6 anos, aproximadamente um terço eram do sexo masculino e a maioria apresentava neuralgia do tipo I. O ramo mais afetado foi o maxilar (V2). O tempo de recorrência após a cirurgia foi em média de 11,8 meses para CPB e 9,0 meses para DM. Foram vistas complicações apenas na microcirurgia. Conclusões: A DM apresentou recidiva mais precoce da dor em comparação à CPB. Além disso, apresentou uma taxa de recorrência mais alta do que a descrita na literatura, o que é possivelmente explicado pelo tipo de enxerto (músculo) usado para separar as estruturas neurovasculares.

Keywords:

Microvascular Decompression Surgery - Trigeminal Neuralgia - Intractable Pain

Palavras-chave:

Cirurgia de Descompressão Microvascular - Neuralgia do Trigêmeo - Dor Intratável

Authors’ contributions:

JPGC: investigation, methodology, supervision, validation, writing-original draft and writing-review & editing. TVHFO: conceptualization, investigation, methodology, project administration, supervision, writing-original draft and writing-review & editing. AFN: conceptualization, investigation, project administration and supervision. MOT: investigation, methodology and writing-original draft. NVPC: funding acquisition, investigation, methodology and writing-original draft.




Publication History

Received: 24 March 2020

Accepted: 15 June 2020

Article published online:
01 June 2023

© 2021. Academia Brasileira de Neurologia. 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 commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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