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J Neurol Surg B Skull Base 2013; 74(02): 075-081
DOI: 10.1055/s-0033-1333617
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Factors Influencing Decision-making and Outcome in the Surgical Management of Trigeminal Neuralgia

Mohannad B. Ammori
1   School of Medicine, University of Manchester, Oxford Road, Manchester, United Kingdom
,
Andrew T. King
2   Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
,
Rekha Siripurapu
3   Department of Neuroradiology, Salford Royal Hospital, Salford, United Kingdom
,
Amit V. Herwadkar
3   Department of Neuroradiology, Salford Royal Hospital, Salford, United Kingdom
,
Scott A. Rutherford
2   Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
› Author Affiliations
Further Information

Publication History

18 June 2012

11 October 2012

Publication Date:
07 February 2013 (online)

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Abstract

Objectives The aim was to optimize the algorithm of operative intervention for trigeminal neuralgia (TN).

Design A multivariate analysis was undertaken to determine factors that had influenced both the initial choice of surgical intervention and the subsequent outcomes.

Setting The study was undertaken with patients who underwent microvascular decompression (MVD) or percutaneous glycerol injection (PGI) for TN between 2007 and 2009.

Participants Seventy-one consecutive patients (43 female) were selected.

Main Outcome Measures Data were prospectively recorded and included demographics, etiology, and presentation of TN, duration of symptoms, neurovascular contact, and the outcomes of surgery.

Results The response rates for MVD and PGI were 96.2% and 87.5%, respectively. The recurrence rates were 9.8% following MVD and 33.3% following PGI. Multivariate analyses confirmed multiple sclerosis and the identification of neurovascular contact as the only factors predictive of the choice of surgical intervention and the risk of recurrence following MVD.

Conclusions Our approach to choosing an operative intervention has been validated. The presence of neurovascular contact and the diagnosis of multiple sclerosis influenced the choice of surgery and were predictive of subsequent outcome. Both MVD and PGI offer effective treatment options for TN. Surgery should be offered early when medical management fails.

Keywords

trigeminal neuralgia - microvascular decompression - percutaneous glycerol injection - neurovascular contact - multiple sclerosis
 

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