1
|
Slavin KV. Commentary: Neurovascular Compression in Patients With Trigeminal Neuralgia May Be Associated With Worse Outcomes After Primary Percutaneous Rhizotomy. Neurosurgery 2024; 95:e22-e23. [PMID: 38661381 DOI: 10.1227/neu.0000000000002967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago , Illinois , USA
| |
Collapse
|
2
|
Nair SK, Oh HJ, Kalluri A, Ejimogu NE, Al-Khars H, Abdulrahim M, Xia Y, Yedavalli V, Jackson CM, Huang J, Lim M, Bettegowda C, Xu R. A history of stereotactic radiosurgery may predict failure of procedure following percutaneous glycerol rhizotomy for trigeminal neuralgia. Neurosurg Rev 2024; 47:289. [PMID: 38907766 DOI: 10.1007/s10143-024-02528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Both stereotactic radiosurgery (SRS) and percutaneous glycerol rhizotomy are excellent options to treat TN in patients unable to proceed with microvascular decompression. However, the influence of prior SRS on pain outcomes following rhizotomy is not well understood. METHODS We retrospectively reviewed all patients undergoing percutaneous rhizotomy at our institution from 2011 to 2022. Only patients undergoing percutaneous glycerol rhizotomy following SRS (SRS-rhizotomy) or those undergoing primary glycerol rhizotomy were considered. We collected basic demographic, clinical, and pain characteristics for each patient. Additionally, we characterized pain presentation and perioperative complications. Immediate failure of procedure was defined as presence of TN pain symptoms within 1-week of surgery, and short-term failure was defined as presence of TN pain symptoms within 3-months of surgery. A multivariate logistic regression model was used to evaluate the relationship of a history SRS and failure of procedure following percutaneous glycerol rhizotomy. RESULTS Of all patients reviewed, 30 had a history of SRS prior to glycerol rhizotomy whereas 371 underwent primary percutaneous glycerol rhizotomy. Patients with a history of SRS were more likely to endorse V3 pain symptoms, p = 0.01. Additionally, patients with a history of SRS demonstrated higher preoperative BNI pain scores, p = 0.01. Patients with a history of SRS were more likely to endorse preoperative numbness, p < 0.0001. A history of SRS was independently associated with immediate failure [OR = 5.44 (2.06-13.8), p < 0.001] and short-term failure of glycerol rhizotomy [OR = 2.41 (1.07-5.53), p = 0.03]. Additionally, increasing age was found to be associated with lower odds of short-term failure of glycerol rhizotomy [OR = 0.98 (0.97-1.00), p = 0.01] CONCLUSIONS: A history of SRS may increase the risk of immediate and short-term failure following percutaneous glycerol rhizotomy. These results may be of use to patients who are poor surgical candidates and require multiple noninvasive/minimally invasive options to effectively manage their pain.
Collapse
Affiliation(s)
- Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Hyun Jong Oh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Anita Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Nna-Emeka Ejimogu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Hussain Al-Khars
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Mostafa Abdulrahim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Vivek Yedavalli
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St. Zayed Tower 6-6132, Baltimore, MD, 21287, USA.
| |
Collapse
|
3
|
Asadauskas A, Luedi MM, Urman RD, Andereggen L. Modern Approaches to the Treatment of Acute Facial Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01260-4. [PMID: 38713367 DOI: 10.1007/s11916-024-01260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW Acute facial pain presents a complex challenge in medical practice, requiring a comprehensive and interdisciplinary approach to its management. This narrative review explores the contemporary landscape of treating acute facial pain, delving into pharmacological, non-pharmacological, and advanced interventions. The significance of tailored treatment strategies, rooted in the diverse etiologies of facial pain, such as dental infections, trigeminal neuralgia, temporomandibular joint disorders, sinusitis, or neurological conditions like migraines or cluster headaches, is underscored. We particularly emphasize recent advances in treating trigeminal neuralgia, elucidating current treatment concepts in managing this particular acute facial pain. RECENT FINDINGS Recent research sheds light on various treatment modalities for acute facial pain. Pharmacotherapy ranges from traditional NSAIDs and analgesics to anticonvulsants and antidepressants. Non-pharmacological interventions, including physical therapy and psychological approaches, play pivotal roles. Advanced interventions, such as nerve blocks and surgical procedures, are considered in cases of treatment resistance. Moreover, we explore innovative technologies like neuromodulation techniques and personalized medicine, offering promising avenues for optimizing treatment outcomes in acute facial pain management. Modern management of acute facial pain requires a nuanced and patient-centric approach. Tailoring treatment strategies to the individual's underlying condition is paramount. While pharmacotherapy remains a cornerstone, the integration of non-pharmacological interventions is essential for comprehensive care. Advanced interventions should be reserved for cases where conservative measures prove inadequate. Furthermore, leveraging innovative technologies and personalized medicine holds promise for enhancing treatment efficacy. Ultimately, a holistic approach that considers the diverse needs of patients is crucial for effectively addressing acute facial pain.
Collapse
Affiliation(s)
- Auste Asadauskas
- Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Lukas Andereggen
- Department of Neurosurgery, Cantonal Hospital of Aarau, Aarau, Switzerland.
- Faculty of Medicine, University of Bern, Bern, Switzerland.
| |
Collapse
|
4
|
Li S, Liao C, Cheng G, Wu Y, Zhang W. Proximal trigeminal nerve atrophy is associated with favourable outcomes and persistent facial numbness following percutaneous balloon compression for primary trigeminal neuralgia. Acta Neurochir (Wien) 2023; 165:3867-3876. [PMID: 37953302 DOI: 10.1007/s00701-023-05849-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/15/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Whether nerve atrophy can affect the prognosis of primary trigeminal neuralgia (PTN) patients undergoing percutaneous balloon compression (PBC) remains unclear. This study aimed to determine the association between nerve characteristics observed on preoperative magnetic resonance imaging (MRI) and PBC outcomes. METHODS Between January 2019 and December 2022, a cohort of 58 patients with unilateral PTN treated with PBC were analysed retrospectively and included in this study. The relationship between MRI findings, including the proximal and distal nerve cross-sectional areas (CSAs), and favourable pain outcomes (BNI Grades I-III) was analysed through Kaplan‒Meier analysis. RESULTS After a mean follow-up period of 23.8 ± 13.0 months (range, 6-50 months), 48 (82.8%) patients with PTN were pain free with or without medication. A smaller proximal CSA ratio (proximal CSA of the affected nerve/proximal CSA of the unaffected nerve) was significantly associated with favourable outcomes. The Kaplan-Meier survival analysis showed that patients with proximal nerve atrophy (proximal CSA ratio ≤ 87% after receiver operating characteristic curve analysis) had a higher estimated 4-year probability of maintaining a favourable outcome than those without nerve atrophy (94.4% vs. 30.8%, p = 0.005). In addition, patients with proximal nerve atrophy were more likely to suffer from postoperative persistent facial numbness. CONCLUSIONS Proximal nerve atrophy is correlated with both favourable outcomes and persistent facial numbness following PBC. Prospective studies are required to determine the optimal duration and pressure of balloon compression in relation to the proximal CSA ratio to achieve better pain outcomes and less facial numbness.
Collapse
Affiliation(s)
- Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Guo Cheng
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Yiwei Wu
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, affiliated to Shanghai JiaoTong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
| |
Collapse
|
5
|
Castelli N, Innocenti N, Ferroli P, Saladino A, Broggi G, Tramacere I, Carone G, Levi V, Rizzi M, Nazzi V. Microvascular decompression for trigeminal neuralgia: a single-center experience with 516 cases, including 32 patients with multiple sclerosis. Acta Neurochir (Wien) 2023; 165:3887-3893. [PMID: 37945996 DOI: 10.1007/s00701-023-05872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the effectiveness and long-term pain relief of microvascular decompression (MVD) for "typical" trigeminal neuralgia (TN), including patients affected by multiple sclerosis (MS). METHODS Between January 2011 and December 2022, 516 consecutive patients presenting with trigeminal neuralgia and a diagnosed neurovascular conflict at MRI underwent microvascular decompression surgery in our neurosurgery department. Ten surgeons with different ages and experiences performed the surgical procedures. Pain improvement, re-operation rate, and complication rates were retrospectively collected and analyzed. RESULTS 516 patients were included (214 males 302 females, ranging from 12 to 87 years), including 32 patients with multiple sclerosis. Neurovascular compression was found in all cases during surgery. Barrow Neurological Institute pain intensity scale with a score of I was achieved in 404 patients (78,29%), a score II or III was obtained in 100 cases (19,37%) and a score of IV and V in 12 patients (2,32%). In the multiple sclerosis subset of patients, a BNI score of I was achieved in 21/32 (65.62%). The pain recurrence rate of our series was 15.11%. The follow-up for all patients was at least of 13 months, with a mean follow-up of 41.93 months (± 17.75 months, range 13-91 months). Neither intraoperative mortality nor major intra-operative complications occurred in the analyzed series. The re-operation rate was 12.98%. Thermorhizotomy, percutaneous balloon compression, cyber-knife radiosurgery, or new MVD were the surgical techniques utilized for re-operations. CONCLUSIONS MVD may be considered an effective and safe surgical technique for TN, and in patients affected by multiple sclerosis, it may be proposed even if a less favorable outcome has to be expected with respect to classic TN patients. Larger studies focusing on the relation of multiple sclerosis with neurovascular compression are required.
Collapse
Affiliation(s)
- Nicolò Castelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Niccolò Innocenti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Carone
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Michele Rizzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
6
|
Ismail R, Schartz D, Hoang T, Kessler A. Middle meningeal artery pseudoaneurysm and pterygoid plexus fistula following percutaneous radiofrequency rhizotomy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23237. [PMID: 37931246 PMCID: PMC10631543 DOI: 10.3171/case23237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Percutaneous treatment for trigeminal neuralgia is a safe and effective therapeutic methodology and can be accomplished in the form of balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation. These procedures are generally well tolerated and demonstrate minimal associated morbidity. Moreover, vascular complications of these procedures are exceedingly rare. OBSERVATIONS We present the case of a 64-year-old female with prior microvascular decompression and balloon rhizotomy who presented after symptom recurrence and underwent a second balloon rhizotomy at our institution. Soon thereafter, she presented with pulsatile tinnitus and a right preauricular bruit on physical examination. Subsequent imaging revealed a middle meningeal artery (MMA) to pterygoid plexus fistula and an MMA pseudoaneurysm. Coil and Onxy embolization were used to manage the pseudoaneurysm and fistula. LESSONS This case illustrates the potential for MMA pseudoaneurysm formation as a complication of percutaneous trigeminal balloon rhizotomy, which has not been seen in the literature. Concurrent MMA-pterygoid plexus fistula is also a rarity demonstrated in this case.
Collapse
|
7
|
Li S, Liao C, Yang X, Zhang W. Association of concomitant continuous pain in trigeminal neuralgia with a narrow foramen ovale. Front Neurol 2023; 14:1277654. [PMID: 38020635 PMCID: PMC10644226 DOI: 10.3389/fneur.2023.1277654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background The pathogenesis of concomitant continuous pain remains unclear and is worthy of further study. In this clinical study, we aimed to explore the potential role of a narrow foramen ovale in the development of concomitant continuous pain. Methods A total of 108 patients with classical trigeminal neuralgia affecting the third branch of the trigeminal nerve and 46 healthy individuals were enrolled in this study. Three-dimensional reconstructed computerized tomography images of all participants were collected, and the morphometric features of the foramen ovale were examined by two investigators who were blinded to the clinical data of the patients. Results In this cohort, patients with concomitant continuous pain suffered from more sensory abnormalities (18.4% vs. 2.9%, p = 0.015) and responded more poorly to medication (74.3% vs. 91.9%, p = 0.018) than patients without concomitant continuous pain. While no significant differences regarding the mean length (5.02 mm vs. 5.36 mm, p > 0.05) and area (22.14 mm2 vs. 23.80 mm2, p > 0.05) were observed between patients with and without concomitant continuous pain, the mean width of the foramen ovale on the affected side in patients with concomitant continuous pain was significantly narrower than that in patients without concomitant continuous pain (2.01 mm vs. 2.48 mm, p = 0.003). Conclusion This neuroimaging and clinical study demonstrated that the development of concomitant continuous pain was caused by the compression of the trigeminal nerve owing to a narrow foramen ovale rather than responsible vessels in classical trigeminal neuralgia.
Collapse
|
8
|
Kalluri AL, So RJ, Nair SK, Materi J, Wang D, Behera N, Kornberg MD, Huang J, Lim M, Bettegowda C, Xu R. The role of multiple sclerosis subtype in microvascular decompression outcomes for patients with trigeminal neuralgia. Clin Neurol Neurosurg 2023; 233:107967. [PMID: 37703615 DOI: 10.1016/j.clineuro.2023.107967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES While patients with concomitant trigeminal neuralgia (TN) and multiple sclerosis (MS) are understood to experience a more intractable pain phenotype, whether TN pain outcomes differ by the presenting MS subtype is not well characterized. This study's objective is to compare post-operative pain and numbness outcomes following microvascular decompression (MVD) in TN patients with either relapsing-remitting MS (RRMS) or progressive MS. METHODS We retrospectively reviewed all TN patients who underwent MVDs at our institution from 2007 to 2020. Of the 1044 patients reviewed, 45 (4.3%) patients with MS were identified. Patient demographics, procedural characteristics, and post-operative pain and numbness scores were recorded and compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions. RESULTS Of the resulting 45 MS patients, 34 (75.6%) patients presented with the RRMS subtype, whereas 11 (24.4%) patients exhibited progressive MS. Using an adjusted multivariate ordinal regression, the subtype of MS was not significantly associated with the Barrow Neurological Institute (BNI) pain score at final follow-up. Using a Kaplan-Meier survival analysis and a multivariate Cox proportional hazards regression, respectively, RRMS was significantly associated with a shorter post-operative pain-free interval (p = 0.04) as well as a greater risk for pain recurrence (p = 0.02). CONCLUSIONS Although the degree of pain at final follow-up may not differ, RRMS patients are at increased risk for pain recurrence following MVD for TN. These results align with a growing understanding that neuroinflammation may play a significant role in TN pain.
Collapse
Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Raymond J So
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joshua Materi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Dorothy Wang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Niranjan Behera
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael D Kornberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| |
Collapse
|
9
|
Xia Q, Huang H, Ma Y, Wang Q, Wang B, Jing F, Xu Y, Li Y, Zhou B. Relationship between compression time and long-term hypoesthesia in primary trigeminal neuralgia treated with percutaneous balloon compression. Neurosurg Rev 2023; 46:212. [PMID: 37642744 DOI: 10.1007/s10143-023-02124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
Percutaneous balloon compression is a surgical method for the treatment of trigeminal neuralgia, but one of the surgical parameters, compression time, is inconclusive. To investigate the effect of compression time during balloon compression on long-term postoperative hypoesthesia in patients with primary trigeminal neuralgia and to provide guidance on relevant parameters for balloon compression in the treatment of primary trigeminal neuralgia, we conducted a nested case-control study. Patients with primary trigeminal neuralgia treated by balloon compression from March 2013 to September 2013 were divided into case group and control group according to whether there were still symptoms of hypoesthesia at present. The relationship between the compression time of balloon compression and long-term hypoesthesia was analyzed. A total of 289 trigeminal neuralgia patients treated with percutaneous balloon compression were included in this study. Multivariate logistic regression showed that compression time was significantly correlated with long-term hypoesthesia (OR = 1.91, 95% CI = 1.13-3.23, P = 0.02), and compression time was greater than one. The risk of hypoesthesia in the long-term when the compression time is longer than 1 min is 1.93 times that of 1 min. PBC is a safe and effective surgical method, and the long-term hypoesthesia is related to the compression time during operation. The longer the compression time during operation, the greater the risk of long-term hypoesthesia.
Collapse
Affiliation(s)
- Qiu Xia
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, Liaoning, China
| | - Haitao Huang
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Yi Ma
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Quancai Wang
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Bin Wang
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Fangkun Jing
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Yangxi Xu
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Yanfeng Li
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China.
| | - Bo Zhou
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, Liaoning, China.
| |
Collapse
|
10
|
Li S, Cheng G, Wu Y, Liao C, Zhang W. Long-term pain outcomes in trigeminal neuralgia patients with concomitant continuous pain: a comparison of first-time microvascular decompression and percutaneous balloon compression. Neurosurg Rev 2023; 46:183. [PMID: 37486589 DOI: 10.1007/s10143-023-02089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo Cheng
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Wu
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
11
|
Chojak R, Koźba-Gosztyła M, Gaik M, Madej M, Majerska A, Soczyński O, Czapiga B. Meningitis after elective intracranial surgery: a systematic review and meta-analysis of prevalence. Eur J Med Res 2023; 28:184. [PMID: 37291583 DOI: 10.1186/s40001-023-01141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Meningitis is a potential complication of elective intracranial surgery (EIS). The prevalence of meningitis after EIS varies greatly in the literature. The objective of this study was to estimate the overall pooled prevalence of meningitis following EIS. Four databases (PubMed, Scopus, Web of Science, and Embase) were searched to identify relevant studies. Meta-analyses of proportions were used to combine data. Cochran's Q and I2 statistics were used to assess and quantify heterogeneity. Additionally, several subgroup analyses were conducted to investigate the source of heterogeneity and examine differences in the prevalence based on variables such as geographical regions, income level, and meningitis type. The meta-analysis included 83 studies (30 959 patients) from 26 countries. The overall pooled prevalence of meningitis after EIS was 1.6% (95% CI 1.1-2.1), with high heterogeneity present (I2 = 88%). The pooled prevalence in low- to middle-income countries and high-income countries was 2.7% (95% CI 1.6-4.1) and 1.2% (95% CI 0.8-1.7), respectively. Studies that reported only aseptic meningitis had a pooled prevalence of 3.2% (95% CI 1.3-5.8). The pooled prevalence was 2.8% (95% CI 1.5-4.5) in studies that reported only bacterial meningitis. Similar prevalence rates of meningitis were observed in the subgroups of tumor resection, microvascular decompression, and aneurysm clipping. Meningitis is a rare but not exceptional complication following EIS, with an estimated prevalence of 1.6%.
Collapse
Affiliation(s)
- Rafał Chojak
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland.
| | | | - Magdalena Gaik
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Marta Madej
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Aleksandra Majerska
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Oskar Soczyński
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
| |
Collapse
|
12
|
Howard SD, Soti V. How Far Has Radiofrequency Thermocoagulation Come Along as a Treatment Procedure in Treating Trigeminal Neuralgia Patients? Cureus 2023; 15:e40311. [PMID: 37313286 PMCID: PMC10259628 DOI: 10.7759/cureus.40311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 06/15/2023] Open
Abstract
Trigeminal neuralgia (TN) refers to sudden shooting pain in areas innervated by trigeminal nerves originating from the Gasserian ganglion. Physicians initially manage it by prescribing drugs, such as carbamazepine. Surgical intervention is the next best option if patients do not respond to drug treatments. These procedures include microvascular decompression, rhizotomy, balloon compression, and gamma knife surgery. However, less optimal patient outcomes, recurrences, adverse effects, and high costs have necessitated alternative surgical interventions to treat such patients. Radiofrequency thermocoagulation (RFT) has emerged as a minimally invasive, safer, and effective surgical option in treating TN patients. Despite research showing RFT's safety and effectiveness, neurosurgical healthcare providers do not frequently use it to treat TN patients. Lack of universal standardized protocol, and minimal awareness of its efficacy in specific cohorts, such as geriatric patients, may lead to RFT underutilization. Hence, this review highlights RFT's advancement as a robust alternative to traditional surgical approaches in treating TN patients. In addition, it identifies RFT's areas of improvement and its safety and effectiveness in treating elderly TN patients. We followed the Systematic Reviews and Meta-Analyses guidelines for systematic reviews and conducted a literature search between July 2022 and March 2023. Our findings indicate that RFT has evolved significantly over the last decade and a half as a minimally invasive and effective treatment procedure for TN patients. It is more effective as a combined continuous and pulsed RFT than its other subtypes in treating primary TN patients. Moreover, RFT via a transverse puncture through the supraorbital foramen results in lesser inter- and post-procedural complications. Further, there is a slightly lesser incidence of post-procedural adverse effects and complications with RFT through the foramen rotundum. Besides, RFT, performed at a lower temperature of 65 degrees Celsius and a voltage between 64.51 and 79.29 volts, effectively provides pain relief and long-term patient satisfaction. RFT is safe and effective in patients over 60 with primary TN. Interestingly, it is also safe and effective in treating patients over 70 with poor fitness standards of Class II or higher. Despite these remarkable findings, there is still a substantial gap in the literature, specifically concerning the standardized protocol for temperature, voltage, and puncture methods of RFT. Despite the sufficient evidence of combined continuous and pulsed RFT's superiority in efficacy and safety, most researchers still utilize either pulsed or continuous RFT. Studies vary in not only these aspects but also the patient cohorts. For instance, most researchers focus solely on evaluating RFT's efficacy and safety in patients with primary TN, excluding a critical patient population suffering from secondary TN. Nevertheless, sufficient clinical evidence shows that RFT has come of age in treating primary TN patients. However, more extensive studies with large sample sizes of patients with primary and secondary TN with multiple trigeminal nerve affectation will significantly help standardize RFT protocol and its inclusion in the standard clinical practice in treating TN patients.
Collapse
Affiliation(s)
- Stephen D Howard
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Varun Soti
- Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA
| |
Collapse
|
13
|
Rapisarda A, Battistelli M, Izzo A, D'Ercole M, D'Alessandris QG, Polli FM, Santi S, Martinelli R, Montano N. Outcome Comparison of Drug-Resistant Trigeminal Neuralgia Surgical Treatments-An Umbrella Review of Meta-Analyses and Systematic Reviews. Brain Sci 2023; 13:brainsci13040530. [PMID: 37190495 DOI: 10.3390/brainsci13040530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
Medical treatment for trigeminal neuralgia (TN) is not always a feasible option due to a lack of full response or adverse effects. Open surgery or percutaneous procedures are advocated in these cases. Several articles have compared the results among different techniques. Nevertheless, the findings of these studies are heterogeneous. Umbrella reviews are studies sitting at the peak of the evidence pyramid. With this umbrella review, we provided a systematic review of the outcomes of the surgical procedures used for TN treatment. Only systematic reviews and meta-analyses were included following the PRISMA guidelines. Ten articles were enrolled for qualitative and quantitative assessment. Level of evidence was quantified using a specific tool (AMSTAR-2). Results were heterogenous in terms of outcome and measurements. Microvascular decompression (MVD) appeared to be the most effective procedure both in the short-term (pain relief in 85-96.6% of cases) and long-term follow-up (pain relief in 64-79% of cases), although showed the highest rate of complications. The results of percutaneous techniques were similar but radiosurgery showed the highest variation in term of pain relief and a higher rate of delayed responses. The use of the AMSTAR-2 tool to quantify the evidence level scored three studies as critically low and seven studies as low-level, revealing a lack of good quality studies on this topic. Our umbrella review evidenced the need of well-designed comparative studies and the utilization of validated scales in order to provide more homogenous data for pooled-analyses and meta-analyses in the field of TN surgical treatment.
Collapse
Affiliation(s)
- Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Marco Battistelli
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Samuele Santi
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Renata Martinelli
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
14
|
Nascimento RFV, Pipek LZ, de Aguiar PHP. Is percutaneous balloon compression better than microvascular decompression to treat trigeminal neuralgia? A systematic review and meta-analysis. J Clin Neurosci 2023; 109:11-20. [PMID: 36634472 DOI: 10.1016/j.jocn.2023.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a neuropathic pain that affects one or more branches of the trigeminal nerve. Surgical options after pharmacological failure are Microvascular Decompression (MVD) or percutaneous procedures, which include Balloon Compression (PBC). This study aims to describe pain outcomes and complications after PBC and MVD procedures for patients with trigeminal neuralgia. METHODS We performed a systematic review and meta-analysis on PubMed, EMBASE, LILACS, and Web of Science databases up to April 2022, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and meta-Analysis). Articles that separately describe pain outcome for MVD and PBC were included. MINORS tool was used for bias assessment. Meta-analysis results are presented in forest plot and funnel plot. RESULTS 853 studies were assessed for screening, and 11 studies met the inclusion criteria for this review. A total of 1046 patients underwent PBC and 1324 underwent MVD. The subgroup analysis for patients without multiple sclerosis shows that MVD was associated with lower number of patients with pain than PBC, with an OR value of 0.54 (95 % CI 0.34-0.84). All other analyses evidenced a tendency for better outcomes after the MVD procedure, but with no statistically significant difference. CONCLUSION Considering short and long pain relief, recurrence of pain and total complications for MVD and PBC, our study found that MVD is the best surgical option available for trigeminal neuralgia.
Collapse
Affiliation(s)
| | | | - Paulo Henrique Pires de Aguiar
- Department of Neurosurgery, Santa Paula Hospital, São Paulo, Brazil; Department of Research and Innovation, Laboratory of Cellular and Molecular Biology, FMABC, Santo André, São Paulo, Brazil; Department of Neurology, School of Medicine of Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brazil; State Serviant Public Hospital, São Paulo, Brazil
| |
Collapse
|
15
|
Yoshizaki W, Fujikawa Y, Torikoshi S, Katayama T, Iwasaki K, Toda H. Effects of microvascular decompression on quality-of-life in trigeminal neuralgia patients aged 70 years and older. Surg Neurol Int 2023; 14:41. [PMID: 36895226 PMCID: PMC9990813 DOI: 10.25259/sni_997_2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Background Trigeminal neuralgia (TN) occasionally affects older adults, frequently worsens, and becomes refractory to medication. Older adult patients with TN may consider microvascular decompression (MVD) for their treatment. No study examines MVD effects on older adult TN patients' health-related quality of life (HRQoL). The present study evaluates the HRQoL of TN patients aged 70 years and older before and after MVD. Methods Adult TN patients who underwent MVD evaluated their HRQoL using the 36-Item Short-form (SF-36) Health Survey before and 6 months after MVD. The patients were divided into four groups according to their decade of age. The clinical parameters and operative outcomes were analyzed statistically. The SF-36 physical, mental, and role social component summary scores and eight domain scale scores were analyzed using a twoway repeated-measures analysis of variance (ANOVA) to compare the effects of age group and preoperative and postoperative time points. Results Among 57 adult patients (34 women, 23 men; mean age, 69 years; range, 30-89 years), 21 patients were in their seventies, and 11 were in their eighties. The SF-36 scores of patients in all age groups improved after MVD. Two-way repeated-measures ANOVA demonstrated a significant age group effect on the physical component summary and its physical functioning domain. A time point effect was significant on all component summaries and domains. There was a significant interaction between age group and time point effects on the bodily pain domain. These results suggested that patients 70 years and older had significant postoperative HRQoL improvement, but their improvement of physical-related HRQoL and multiple physical pain issues were limited. Conclusion Impaired HRQoL in TN patients aged 70 years and older can improve after MVD. Careful management of multiple comorbidities and surgical risks enables MVD to be an appropriate treatment for older adult patients with refractory TN.
Collapse
Affiliation(s)
- Wataru Yoshizaki
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| | - Yoshiki Fujikawa
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| | | | - Toshiro Katayama
- Department of Health Science, Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| | - Hiroki Toda
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka
| |
Collapse
|
16
|
Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smilkov EA, Bendtsen L, Maarbjerg S. Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients. J Headache Pain 2022; 23:145. [PMCID: PMC9675260 DOI: 10.1186/s10194-022-01520-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD. Objectives We aimed to assess outcome and complications after microvascular decompression from our center. Methods We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors. Results Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I – BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9–12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1–6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others. Conclusion Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively. Trial registration Clinical.trials.gov registration no. NCT04445766. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01520-x.
Collapse
Affiliation(s)
- Anne Sofie Schott Andersen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Tone Bruvik Heinskou
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Per Rochat
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Jacob Bertram Springborg
- grid.4973.90000 0004 0646 7373Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet – Blegdamsvej, 2100 Copenhagen, Denmark
| | - Navid Noory
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Emil Andonov Smilkov
- grid.475435.4Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet – Glostrup, 2600 Glostrup, Denmark
| | - Lars Bendtsen
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Stine Maarbjerg
- grid.475435.4Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet – Glostrup, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| |
Collapse
|
17
|
Yu G, Leng J, Xia Y, Min F, Xiang H. Microvascular decompression: Diversified of imaging uses, advantages of treating trigeminal neuralgia and improvement after the application of endoscopic technology. Front Neurol 2022; 13:1018268. [DOI: 10.3389/fneur.2022.1018268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Classical trigeminal neuralgia (CTN) is a unilateral and severe facial pain disease, which seriously affects the patient's quality of life. Microvascular decompression (MVD) is currently the most effective surgical method, and it is the only treatment for the etiology of CTN. Imaging for MVD has been increasingly used, and the advantages and disadvantages of endoscopy-assisted vascular decompression surgery have been controversially debated. In this review, we aimed to discuss the advantages of MVD in the treatment of patients with CTN, the importance of using imaging in disease management, and the improvements of vascular decompression surgery through the application and maturity of endoscopic techniques. Compared with other surgical methods, MVD has more prominent short- and long-term treatment effects. Its selection depends on the accurate discovery of neurovascular compression by preoperative imaging. Moreover, magnetic resonance imaging plays a diverse role in MVD, not only in identifying the responsible vessels but also in determining the prognosis and as a tool for scientific research. The use of endoscopic techniques provides improved visualization of the MVD and additional benefits for vascular decompression surgery.
Collapse
|
18
|
The impact of needle location on clinical outcome of radiofrequency rhizotomy for trigeminal neuralgia. Acta Neurochir (Wien) 2022; 164:1575-1585. [PMID: 35484311 DOI: 10.1007/s00701-022-05224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Radiofrequency thermocoagulation trigeminal rhizotomy (RT-TR) through the foramen ovale is a minimally invasive treatment for trigeminal neuralgia. Navigation of magnetic resonance imaging (MRI) and CT fusion imaging is a well-established method for cannulation of the Gasserian ganglion. In this study, we use the inline measurements from fusion image to analyze the anatomical parameters between the actual and simulation trajectories and compare the short- and intermediate-term outcomes according to determinable factors. METHODS The study included thirty-six idiopathic neuralgia patients who had undergone RT-TR with MRI and CT fusion image as a primary modality or repeated procedures. RESULTS Among thirty-six treated patients, the inline length of the trigeminal cistern was longer for the simulated trajectory (8.4 ± 2.4 versus 6.5 ± 2.8 mm; p < 0.05), and the predominant structure at risk extrapolated from the inline trajectory was the brainstem, which signified a more medially directed route, in contrast with the equal weighting of temporal lobe and brainstem for the actual trajectory. The preoperative visual analogue scale (VAS) was 9.3 ± 1.0, which decreased to 2.5 ± 2.6 and 2.9 ± 3.1 at first (mean, 3 months) and second (mean, 14 months) postoperative follow-up, respectively. The postoperative VAS scores at the two follow-ups were not statistically significant without a covariate analysis. After adjustment for covariate risk factors, the second follow-up sustained therapeutic benefit was evident in patients with no prior history of related treatment, an ablation temperature greater than 70 °C, and needle location within or adjacent to the trigeminal cistern. CONCLUSIONS This preliminary study demonstrated that the needle location between cistern and ganglion also plays a significant role in better intermediate-term results.
Collapse
|