Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. (Heidelberg College of Medicine, Heidelberg, Germany) Neurosurgery. 2001;48:1261-1267.

Pain Practice ◽  
2001 ◽  
Vol 1 (4) ◽  
pp. 382-383 ◽  
Author(s):  
Volker M. Tronnier ◽  
Dirk Rasche ◽  
Jurgen Hamer ◽  
Anna-Lena Kienle ◽  
Stefan Kunze
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Idiopathic Trigeminal Neuralgia

Treatment of Idiopathic Trigeminal Neuralgia: Comparison of Long-term Outcome after Radiofrequency Rhizotomy and Microvascular Decompression

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1261-1268 ◽  
Author(s):  
Volker M. Tronnier ◽  
Dirk Rasche ◽  
Jürgen Hamer ◽  
Anna-Lena Kienle ◽  
Stefan Kunze
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Term Outcome ◽  
Strong Argument ◽  
Long Term Outcome ◽  
Kaplan Meier ◽  
Idiopathic Trigeminal Neuralgia ◽  
Percutaneous Trigeminal Rhizotomy

Abstract OBJECTIVE To evaluate the long-term outcome of patients after either percutaneous trigeminal rhizotomy or microvascular decompression (MVD) for idiopathic trigeminal neuralgia at a single institution. METHODS From 1977 to 1997, 316 radiofrequency lesion procedures and 378 MVDs were performed. Questionnaires were sent to all patients who were alive in 1981, 1982, 1992, and 1998. For all other patients, interviews were conducted with their relatives and general practitioners. A retrospective comparative analysis was performed with Kaplan-Meier probability curves as of the latest follow-up date. In addition, 80 patients who underwent MVD were examined postoperatively with quantitative sensory measurements by use of von Frey hairs. RESULTS Two hundred twenty-five patients who underwent MVD and 206 patients who underwent radiofrequency could be analyzed retrospectively in detail. Overall, there was a 50% risk for recurrence of pain 2 years after percutaneous radiofrequency rhizotomy. Conversely, 64% of patients who underwent MVD remained completely pain free 20 years postoperatively. Patients without sensory impairment after MVD were pain free significantly longer than patients who experienced postoperative hypesthesia or partial rhizotomy. CONCLUSION Because it is curative and nondestructive, MVD is considered the treatment of choice for trigeminal neuralgia in otherwise healthy people. In our study, it proved to be a more effective and long-lasting procedure for patients with typical trigeminal neuralgia than radiofrequency rhizotomy. Patients without postoperative sensory deficit remained pain free significantly longer, which is a strong argument against the “trauma” hypothesis of this procedure.

The long-term outcome of microvascular decompression for trigeminal neuralgia

2010 ◽  
Vol 24 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Zaid Sarsam ◽  
Marta Garcia-Fiñana ◽  
Turo J. Nurmikko ◽  
Thelekat R. K. Varma ◽  
Paul Eldridge
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Term Outcome ◽  
Long Term Outcome

MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA IN THE ELDERLY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Thomas Günther ◽  
Venelin M. Gerganov ◽  
Lennart Stieglitz ◽  
Wolf Ludemann ◽  
Amir Samii ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Safe Procedure ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Younger Patients ◽  
The Mean

Abstract OBJECTIVE Multiple studies have proved that microvascular decompression (MVD) is the treatment of choice in cases of medically refractory trigeminal neuralgia (TN). In the elderly, however, the surgical risks related to MVD are assumed to be unacceptably high and various alternative therapies have been proposed. We evaluated the outcomes of MVD in patients aged older than 65 years of age and compared them with the outcomes in a matched group of younger patients. The focus was on procedure-related morbidity rate and long-term outcome. METHODS This was a retrospective study of 112 patients with TN operated on consecutively over 22 years. The main outcome measures were immediate and long-term postoperative pain relief and neurological status, especially function of trigeminal, facial, and cochlear nerves, as well as surgical complications. A questionnaire was used to assess long-term outcome: pain relief, duration of a pain-free period, need for pain medications, time to recurrence, pain severity, and need for additional treatment. RESULTS The mean age was 70.35 years. The second and third branches of the trigeminal nerve were most frequently affected (37.3%). The mean follow-up period was 90 months (range, 48–295 months). Seventy-five percent of the patients were completely pain free, 11% were never pain free, and 14% experienced recurrences. No statistically significant differences existed in the outcome between the younger and older patient groups. Postoperative morbidity included trigeminal hypesthesia in 6.25%, hypacusis in 5.4%, and complete hearing loss, vertigo, and partial facial nerve palsy in 0.89% each. Cerebrospinal fluid leak and meningitis occurred in 1 patient each. There were no mortalities in both groups. CONCLUSION MVD for TN is a safe procedure even in the elderly. The risk of serious morbidity or mortality is similar to that in younger patients. Furthermore, no significant differences in short- and long-term outcome were found. Thus, MVD is the treatment of choice in patients with medically refractory TN, unless their general condition prohibits it.

scholarly journals Surgical Outcomes After Microvascular Decompression With Internal Neurolysis and Partial Neurectomy for Patients With Trigeminal Neuralgia and Negative Neurovascular Compression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Amanda Carpenter ◽  
James K Liu
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Neurovascular Compression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Root Entry Zone ◽  
Internal Neurolysis ◽  
Facial Numbness

Abstract INTRODUCTION Microvascular decompression (MVD) is an effective and durable treatment for patients with trigeminal neuralgia (TN) due to neurovascular compression (NVC). In the absence of NVC, the traditional MVD is less effective in achieving long-term pain relief. Internal neurolysis at the root entry zone (REZ) of the trigeminal nerve has been described in the literature; however, there are few reports of long-term outcome after this procedure. Furthermore, this is the first study to combine this procedure with additional partial neurectomy. METHODS This is a retrospective review of the senior author's patients with TN who underwent retrosigmoid craniectomy for MVD with internal neurolysis and partial neurectomy. Primary indications were patients with TN and no evidence of NVC intraoperatively. A total of 9 patients were included in the analysis. Three cases were of recurrent TN. The technique was performed with an 11-blade or arachnoid knife to open the perineurium in a longitudinal fashion at the REZ. A disc dissector was used to comb the fascicles along the longitudinal course, and a partial neurectomy was performed with a microscissors to make three selective cuts into the fascicles at the REZ. Barrow Neurological Institute (BNI) facial pain and numbness scales were used as postoperative assessment. RESULTS At median follow up of 12 mo (range: 2 to 34), 8 of 9 patients (89%) had a BNI-pain score of I (no trigeminal pain, no medications). Two of nine patients (22%) had a BNI-numbness score of I (no numbness); seven (78%) had a BNI-numbness score of II (mild facial numbness that is not bothersome). CONCLUSION Internal neurolysis with partial neurectomy appears to be an effective and potentially durable treatment option for patients with TN (primary or recurrent) without NVC. Larger series with longer follow-up is indicated to further evaluate the utility of this procedure.

The Long-Term Outcome of Microvascular Decompression for Trigeminal Neuralgia

1996 ◽  
Vol 334 (17) ◽  
pp. 1077-1084 ◽  
Author(s):  
Fred G. Barker ◽  
Peter J. Jannetta ◽  
David J. Bissonette ◽  
Mark V. Larkins ◽  
Hae Dong Jho
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Term Outcome ◽  
Long Term Outcome

Gamma Knife stereotactic radiosurgical treatment of idiopathic trigeminal neuralgia: long-term outcome and complications

2007 ◽  
Vol 23 (6) ◽  
pp. E7 ◽  
Author(s):  
Kostas N. Fountas ◽  
Joseph R. Smith ◽  
Gregory P. Lee ◽  
Patrick D. Jenkins ◽  
Rebecca R. Cantrell ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Response Rate ◽  
Initial Response ◽  
Previous Surgery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Idiopathic Trigeminal Neuralgia ◽  
History Of

Object Stereotactic radiosurgery (SRS) with the Gamma Knife (GK) is a rapidly emerging surgical modality in the management of medically refractory idiopathic trigeminal neuralgia (TN). The current study examines the long-term outcome in patients with drug-resistant idiopathic TN who underwent GK surgery at the authors‘ institution. Methods One hundred and six consecutive patients (38 men and 68 women) with proven medically refractory idiopathic TN were included in this retrospective study. Their ages were 41–82 years (mean 72.3 years). All patients underwent SRS with prescribed maximal radiation doses ranging from 70 to 85 Gy. Isocenters 1–3 were used and plugging was used selectively. The follow-up period was 12–72 months (mean 34.3 months). The patients were divided into 2 groups according to their history of previous surgery. Results The initial response rate in patients with no history of previous surgery was 92.9%; in those who had undergone previous surgery, the initial response rate was 85.7%. At the end of the 1st posttreatment year, an excellent outcome was achieved in 82.5% of patients who had not had previous surgery, and in 69.4% of those who had. The respective outcome rates for the 2nd posttreatment year were 78 and 63.5%, respectively. The most common complication was the development of persistent paresthesia, which occurred in 15.8% of patients with no previous surgery and 16.3% of those with previous surgery. Conclusions Stereotactic radiosurgery with the GK is a safe and effective treatment option for patients with medically refractory idiopathic TN.

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