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Gomes-da Silva de Rosenzweig P, Pastrana-Brandes S, Merikansky-Gerson S, Victoria-Garcia LO, Curtius-Caruso MS, Carrillo-Ruiz JD. Factors associated with outcomes following microvascular decompression for the treatment of primary trigeminal neuralgia in adults: a systematic review and meta-analysis. J Dent Anesth Pain Med 2024; 24:227-243. [PMID: 39118815 PMCID: PMC11304043 DOI: 10.17245/jdapm.2024.24.4.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X2 = 46.31; Dof = 15; I2 = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X2 = 23.23; Dof = 10; I2 = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X2 = 21.17; Dof = 9; I2 = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.
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Affiliation(s)
- Pablo Gomes-da Silva de Rosenzweig
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | | | - Salomon Merikansky-Gerson
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - Luis Octavio Victoria-Garcia
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - Magdalena Sophia Curtius-Caruso
- Facultad de Ciencias de la Salud, Centro de Investigación en Ciencias de la Salud (CICSA), Universidad Anáhuac México Norte Huixquilucan, Estado de México, Mexico
| | - José Damián Carrillo-Ruiz
- Coordinación de Neurociencias, Facultad de Psicología, Universidad Anáhuac México, Mexico
- Servicio de Neurocirugía Funcional y Estereotaxia, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
- Dirección de Investigación, Hospital General de México Dr Eduardo Liceaga, Mexico City, Mexico
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Fareed A, Iftikhar Z, Haider R, Shah SI, Ennabe M, Alan A, Weinand M. Awake neurosurgery: Advancements in microvascular decompression for trigeminal neuralgia. Surg Neurol Int 2024; 15:215. [PMID: 38974545 PMCID: PMC11225509 DOI: 10.25259/sni_286_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 07/09/2024] Open
Abstract
Background The treatment landscape for trigeminal neuralgia (TN) involves various surgical interventions, among which microvascular decompression (MVD) stands out as highly effective. While MVD offers significant benefits, its success relies on precise surgical techniques and patient selection. In addition, the emergence of awake surgery techniques presents new opportunities to improve outcomes and minimize complications associated with MVD for TN. Methods A thorough review of the literature was conducted to explore the effectiveness and challenges of MVD for TN, as well as the impact of awake surgery on its outcomes. PubMed and Medline databases were searched from inception to March 2024 using specific keywords "Awake Neurosurgery," "Microvascular Decompression," AND "Trigeminal Neuralgia." Studies reporting original research on human subjects or preclinical investigations were included in the study. Results This review highlighted that MVD emerges as a highly effective treatment for TN, offering long-term pain relief with relatively low rates of recurrence and complications. Awake surgery techniques, including awake craniotomy, have revolutionized the approach to MVD, providing benefits such as reduced postoperative monitoring, shorter hospital stays, and improved neurological outcomes. Furthermore, awake MVD procedures offer opportunities for precise mapping and preservation of critical brain functions, enhancing surgical precision and patient outcomes. Conclusion The integration of awake surgery techniques, particularly awake MVD, represents a significant advancement in the treatment of TN. Future research should focus on refining awake surgery techniques and exploring new approaches to optimize outcomes in MVD for TN.
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Affiliation(s)
- Areeba Fareed
- Global Neurosurgical Alliance, Tucson, Arizona, USA
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Zoha Iftikhar
- Global Neurosurgical Alliance, Tucson, Arizona, USA
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Ramsha Haider
- Global Neurosurgical Alliance, Tucson, Arizona, USA
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Safa Irfan Shah
- Global Neurosurgical Alliance, Tucson, Arizona, USA
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Michelle Ennabe
- Global Neurosurgical Alliance, Tucson, Arizona, USA
- College of Medicine, The University of Arizona College of Medicine-Phoenix, USA
| | - Albert Alan
- Global Neurosurgical Alliance, Tucson, Arizona, USA
- College of Medicine, The University of Arizona College of Medicine-Tucson, USA
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Martin Weinand
- College of Medicine, The University of Arizona College of Medicine-Tucson, USA
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA
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Shi X, Zhang X, Xu L, Xu Z. Neurovascular Compression Syndrome:Trigeminal neuralgia, Hemifacial spasm, Vestibular paroxysmia, Glossopharyngeal neuralgia, four case reports and review of literature. Clin Neurol Neurosurg 2022; 221:107401. [DOI: 10.1016/j.clineuro.2022.107401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/02/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
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Penn MC, Choi W, Brasfield K, Wu K, Briggs RG, Dallapiazza R, Russin JJ, Giannotta SL, Lee DJ. A Review of Medical and Surgical Options for the Treatment of Facial Pain. Otolaryngol Clin North Am 2022; 55:607-632. [PMID: 35490039 DOI: 10.1016/j.otc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Facial pain is a common medical complaint that is easily misdiagnosed. As a result, this pain often goes mistreated. Despite this, there are a variety of pharmacologic, surgical, and neuromodulatory options for the treatment of facial pain. In this review, the authors detail the forms of facial pain and their treatment options. They discuss the common medications used in the first-line treatment of facial pain and the second-line surgical and neuromodulatory options available to patients when pharmacologic options fail.
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Affiliation(s)
- Marisa C Penn
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wooseong Choi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kaevon Brasfield
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kevin Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Robert G Briggs
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Robert Dallapiazza
- Department of Neurological Surgery, Tulane School of Medicine, Tulane University, New Orleans, LA, USA
| | - Jonathan J Russin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven L Giannotta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darrin J Lee
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Legninda Sop FY, D'Ercole M, Izzo A, Rapisarda A, Ioannoni E, Caricato A, Olivi A, Montano N. The Impact of Neuronavigation on the Surgical Outcome of Microvascular Decompression for Trigeminal Neuralgia. World Neurosurg 2021; 149:80-85. [PMID: 33621673 DOI: 10.1016/j.wneu.2021.02.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) is considered the only etiological treatment for drug-resistant trigeminal neuralgia (TN). Nonetheless, despite the recent technological advances, the risks associated with MVD remain non-negligible. The aim of this study was to evaluate the impact of using neuronavigation on the surgical outcomes of patients with TN submitted for MVD. METHODS We analyzed 30 consecutive patients (11 men, 19 women) who underwent MVD for TN between January 2019 and December 2019. Patients were divided in 2 groups according to the use of neuronavigation (group A: MVD with neuronavigation; group B: MVD without neuronavigation). The impact of neuronavigation was assessed on the following parameters: craniotomy size, surgical duration, mastoid air cell opening, postoperative cerebrospinal fluid (CSF) leakage and other complications occurrence, and length of hospitalization. The acute pain relief and the Barrow Neurological Institute score at follow-up were used to evaluate the functional outcome. RESULTS The craniotomy size, the surgical duration, and the CSF leak incidence were significantly reduced in group A compared with group B (P = 0.0009, P = 0.0369, and P = 0.0406, respectively). The incidence of mastoid air cell opening, and the length of hospitalization were reduced in group A compared with group B, although these differences were not statistically significant. We obtained an acute pain relief in all cases, and the Barrow Neurological Institute score at follow-up was significantly reduced (P < 0.0001). CONCLUSIONS Neuronavigation is a useful tool that significantly reduced craniotomy size, surgical duration, and CSF leak incidence in patients with TN submitted for MVD. We advise to routinely implement neuronavigation in this type of surgery.
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Affiliation(s)
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anselmo Caricato
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy.
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Nova CV, Zakrzewska JM, Baker SR, Riordain RN. Treatment Outcomes in Trigeminal Neuralgia-A Systematic Review of Domains, Dimensions and Measures. World Neurosurg X 2020; 6:100070. [PMID: 32123867 PMCID: PMC7036566 DOI: 10.1016/j.wnsx.2020.100070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/16/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock-like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. METHODS We have conducted a literature search using a wide range of databases (1946-2019 for medical and 2008-2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). RESULTS Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). CONCLUSIONS A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost.
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Affiliation(s)
| | | | - Sarah R. Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Richeal Ni Riordain
- UCL Eastman Dental Institute, London, United Kingdom
- Department of Oral Medicine, Cork University Dental School and Hospital, Cork, Ireland
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Awake microvascular decompression with fat-teflon sandwich technique: Clinical implications of a novel approach for cranial nerve neuralgias. J Clin Neurosci 2019; 64:77-82. [PMID: 31014908 DOI: 10.1016/j.jocn.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/23/2019] [Accepted: 04/12/2019] [Indexed: 11/21/2022]
Abstract
Re-appearance of trigeminal neuralgia (TN) pain following microvascular decompression (MVD) is a challenging issue. A selective ablation with MVD provides the best response in such recurrences. The absence of intra-operative indicator for immediate correction of sub-optimal decompression is the primary factor for failure. We analysed the effectiveness and safety of awake MVD in minimizing failure, by tailoring the procedure according to intra-operative response with re-exploration or additional procedure like internal neurolysis in the same setting, especially in patients without vascular compression and those unfit for General Anesthesia (GA). The prospective study from June 2016 to June 2017 includes one glossopharyngeal neuralgia (GPN) and 6 trigeminal neuralgia (TN). Five cases responded with immediate complete pain relief but in 2 cases, incomplete pain relief resulted in alteration of intraoperative decision. In one case, a partial pain relief, mandated an additional internal neurolysis in the same setting, resulting in complete pain relief while in the other, re-exploration revealed a hidden venous conflict, not identified on MRI following which an additional IN was performed. All cases were followed up with BNI PIS for a minimum of one year without recurrence. Awake MVD is safe and reliable intraoperative neurophysiological prognostic marker of immediate pain relief and provides a window for an immediate correction of sub-optimal decompression with Internal Neurolysis when needed, in the same setting, especially in neuroimaging negative and elderly cases unfit for GA. It has the potential to reduce the rate of re-intervention and increase the overall effectiveness of MVD by specifically ameliorating the pain burden and quality of life.
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