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Zhang Z, Zhao H, Tang Y, Wang B, Yuan Q, Wang H, Cai X, Zhu W, Li S. Microvascular Decompression Using the Gelatin Sponge Insertion Technique for Trigeminal Neuralgia: A Retrospective Cohort Study. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01199. [PMID: 38888321 DOI: 10.1227/ons.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Microvascular decompression (MVD) is the primary surgical intervention for trigeminal neuralgia (TN), with Teflon being the most conventional decompressing material. However, Teflon has been associated with adhesion and granulomas after MVD, which closely correlated with the recurrence of TN. Therefore, we developed a new technique to prevent direct contact between Teflon and nerve. The purpose of this study is to compare the efficacy of MVD using the gelatin sponge (GS) insertion technique with that of Teflon inserted alone in treating primary TN. METHODS We retrospectively analyzed the medical records and the follow-up data of 734 patients with unilateral primary TN who underwent MVD at our center from January 2014 to December 2019. After exclusions, we identified 313 cases of GS-inserted MVD and 347 cases of traditional MVD. The follow-up exceeded 3 years. RESULTS The operating time of the GS-inserted group was longer than that of the Teflon group (109.38 ± 14.77 vs 103.53 ± 16.02 minutes, P < .001). There was no difference between 2 groups in immediate surgical outcomes and postoperative complications. The yearly recurrence rate for GS-inserted MVD was lower at first (1.0%), second (1.2%), and third (1.2%) years after surgery, compared with its counterpart of Teflon group (3.7%, 2.9%, and 1.7% respectively). The first-year recurrence rate (P = .031) and total recurrence rate in 3 years (P = .013) was significantly lower in the GS-inserted group than Teflon group. Kaplan-Meier survival analysis demonstrated better outcomes in GS-inserted MVD groups (P = .020). CONCLUSION The application of the GS insertion technique in MVD reduced first-year postoperative recurrence of TN, with similar complications rates compared with traditional MVD.
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Affiliation(s)
- Zhongding Zhang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Hua Zhao
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Yinda Tang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Baimiao Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Qing Yuan
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Haopeng Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomin Cai
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Wanchun Zhu
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China
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Nurimanov C, Mammadinova I, Menlibayeva K, Kaliyev A, Makhambetov Y, Akshulakov S. The outcomes of microvascular decompression for primary trigeminal neuralgia: insights from a single-center experience and technical advancements. Front Surg 2024; 11:1378717. [PMID: 38840974 PMCID: PMC11150634 DOI: 10.3389/fsurg.2024.1378717] [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: 01/30/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
Background Microvascular decompression (MVD) remains the primary surgical treatment for trigeminal neuralgia due to its positive postoperative results. This study aims to evaluate the outcomes of patients with primary trigeminal neuralgia who underwent MVD. Additionally, the paper offers a detailed explanation of the surgical methodology of MVD employed at the neurosurgical hospital in Kazakhstan. Methods The study involved 165 medical records of patients with trigeminal neuralgia who underwent MVD between 2018 and 2020. Out of these 165 patients, 90 (54.55%) were included in the final analysis and were further evaluated using the Barrow Neurological Institute pain intensity score. Various variables were analyzed, including age, sex, affected side, dermatomes, offending vessel, and surgical intervention type. Moreover, the surgical technique employed at the hospital was described. Results The average follow-up period after the MVD procedure was 32.78 ± 9.91 months. The results indicated that out of the 90 patients, 80 (88.89%) achieved a good outcome as evidenced by BNI scores I and II. It was observed that patients with affected maxillary dermatomas and those with affected ophthalmic + maxillary dermatomas were more likely to experience fair + poor postsurgery BNI scores. On the other hand, patients with neurovascular conflicts involving the maxillary + mandibular dermatomas demonstrated good BNI scores (p = 0.01). Conclusions The outcomes of MVD in patients with primary trigeminal neuralgia showed good BNI scores within this study population. The outcome depended on the affected dermatome of the trigeminal nerve with the vessel. Additionally, patient positioning, intraoperative management including small skin incisions, minimal craniotomy, and precise closure of the dura, as well as intraoperative neurolysis, may contribute to achieving good clinical and satisfactory post-surgery aesthetic outcomes.
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Affiliation(s)
- Chingiz Nurimanov
- Vascular and Functional Neurosurgery Department, National Centre for Neurosurgery, Astana, Kazakhstan
| | - Iroda Mammadinova
- Vascular and Functional Neurosurgery Department, National Centre for Neurosurgery, Astana, Kazakhstan
| | - Karashash Menlibayeva
- Hospital Management Department, National Centre for Neurosurgery, Astana, Kazakhstan
| | - Assylbek Kaliyev
- Vascular and Functional Neurosurgery Department, National Centre for Neurosurgery, Astana, Kazakhstan
| | - Yerbol Makhambetov
- Vascular and Functional Neurosurgery Department, National Centre for Neurosurgery, Astana, Kazakhstan
| | - Serik Akshulakov
- Vascular and Functional Neurosurgery Department, National Centre for Neurosurgery, Astana, Kazakhstan
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Eghlimi RA, Meyer JH, Bendok BR, Zimmerman RS. Commentary: Microvascular Decompression for Treatment of Simultaneous Arterial and Venous Conflict Causing Trigeminal Neuralgia: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e380-e381. [PMID: 37831982 DOI: 10.1227/ons.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Ryan A Eghlimi
- Mayo Clinic Alix School of Medicine, Scottsdale , Arizona , USA
| | - Jenna H Meyer
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix , Arizona , USA
| | - Bernard R Bendok
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix , Arizona , USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix , Arizona , USA
- Department of Radiology, Mayo Clinic Arizona, Phoenix , Arizona , USA
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Mori K, Otani N, Toyooka T, Morita S, Numazawa S, Wada K, Watanabe S. Validation of Efficacy and Safety of TachoSil ® Tissue Sealant for Vessel Transposition in Microvascular Decompression. Oper Neurosurg (Hagerstown) 2023; 25:417-425. [PMID: 37820076 DOI: 10.1227/ons.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Use of TachoSil ® as the transposition material of microvascular decompression (MVD) for hemifacial spasm (HFS) and trigeminal neuralgia (TN) is easy and safe to perform, but the efficacy and safety of this technique are unknown. This study attempted to validate the efficacy and safety of TachoSil ® as a transposition material of MVD. METHODS A retrospective study of the surgical results and complications of 63 patients (35 HFS and 28 TN) treated by the TachoSil ® technique between January 2011 and December 2021 was conducted. The efficacy of the treatment was evaluated by Kaplan-Meier survival analysis. Magnetic resonance imaging follow-up study was performed to detect any adverse events including a mass formation. RESULTS The rate of complete disappearance of HFS was 91.4% at 1 year and estimated to be 85.7% after a 10-year follow-up. The rate of no pain without medication for TN was 85.4% at 1 year and estimated to be 69.0% after a 9-year follow-up. These surgical results are comparable with those previously reported. Flaking of TachoSil ® releasing the offending artery was only recognized in one case (1.6%). Therefore, TachoSil ® can be considered as an effective transposition material for MVD. TachoSil ® did not increase the rate of acute and subacute adverse events such as inflammation and delayed facial palsy. Magnetic resonance imaging follow-up identified no abnormalities including mass that suggested granuloma formation. CONCLUSION The efficacy of the TachoSil ® technique for HFS and TN and the reliability of TachoSil ® as an adhesive material in MVD were verified. No adverse events associated with TachoSil ® use in MVD were found. We conclude that the TachoSil ® technique has relatively long efficacy and safety for MVD.
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Affiliation(s)
- Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital, Tokyo , Japan
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | - Naoki Otani
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo , Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | - Shuhei Morita
- Department of Neurosurgery, Tokyo General Hospital, Tokyo , Japan
| | | | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
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Adidharma P, Prasetya M, Sulistyanto A, Arham A, Fadhil, Oswari S, Keswani RR, Kusdiansah M, Aji YK, Inoue T. Single-surgeon approach in microvascular decompression for trigeminal neuralgia: Lessons from an Indonesian Tertiary-Level Neurological Center. J Clin Neurosci 2023; 115:53-59. [PMID: 37487448 DOI: 10.1016/j.jocn.2023.07.017] [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: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Microvascular decompression (MVD) is effective for refractory trigeminal neuralgia (TN), but its accessibility is often limited in lower-to-middle-income countries (LMICs). This study aims to assess the impact of implementing a single-surgeon policy on MVD for TN in LMICs. METHODS A prospective cohort study was conducted from 2014 to 2020, comparing outcomes between multi-surgeon and single-surgeon policies. Residents were included in MVD procedures starting in 2019. The Barrow Neurological Institute (BNI) pain scale (P), numbness scale (N), and result conclusion scale (P + N) were used to evaluate outcomes (1 week, 1 month, 1 year, and yearly thereafter). Propensity score matching was performed before comparing the groups. Pain-free survival was assessed using Kaplan-Meier and Cox-regression analysis. RESULTS We comprehensively analyzed data from 72 patients with a minimum one-year follow-up. The implementation of the single-surgeon policy had several notable impacts. Firstly, it led to an increased referral rate (p < 0.05) and a reduced duration to surgery (p < 0.05). During MVD, there was a significant increase in the identification of complex compression (p < 0.05) and a reduced frequency of internal neurolysis (p < 0.05). After surgery, the single-surgeon group exhibited a superior pain-control profile (RR 1.9, p < 0.001; ARR 26-36%), higher pain-free survival rate (p < 0.001), lower likelihood of pain recurrence (HR 0.2, p < 0.0001), and fewer additional surgical interventions compared to the multi-surgeon group. Moreover, the involvement of residents did not significantly impact surgical outcomes. CONCLUSIONS Implementing a single-surgeon policy for MVD in LMICs has the potential to improve surgical outcomes, provide social benefits, and offer educational opportunities.
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Affiliation(s)
- Peter Adidharma
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia.
| | - Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Adi Sulistyanto
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Abrar Arham
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Fadhil
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Selfy Oswari
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Ryan Rhiveldi Keswani
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Muhammad Kusdiansah
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Yunus Kuntawi Aji
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia
| | - Takuro Inoue
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta, Indonesia; Department of Neurosurgery, Subarukai Koto Memorial Hospital, Shiga, Japan
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Uhl C, Vajkoczy P. Contact-free transposition and interposition techniques for trigeminal neuralgia: a systematic review. J Neurosurg Sci 2023; 67:36-45. [PMID: 36082834 DOI: 10.23736/s0390-5616.22.05514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Surgical treatment for trigeminal neuralgia (TGN), by means of interposition of material between nerve and offending vessel, has been shown to be highly efficient. In recent years, treatment by means of vessel transposition has become more frequent, as in singular cases of recurrence, nerval reactions towards interposed material have been noted. In this review we research the classic microvascular decompression (MVD) techniques (interposition) as well as the more recent transposition and their effectiveness, considering patient outcomes as well as complications and recurrences. EVIDENCE ACQUISITION We searched online databases MEDLINE and LIVIVO, using key words trigeminal neuralgia AND transposition/ AND sling/ AND non compressive technique/ AND microvascular decompression. EVIDENCE SYNTHESIS We included 8 studies for transposition and 20 studies for the interposition, combining for 2045 patients (302 for transposition and 1743 for interposition). 96.1% of patients in the transposition and 93.1% in the interposition group reported a positive outcome immediately postoperatively. At follow-up, 87.4% in the transposition group (follow-up 51.2 months) and 87.9% of patients in the interposition group (follow-up 36.5 months), reported a positive outcome. 16.2% of patients in the transposition and 13.1% in the interposition group had postoperative complications. Recurrence was reported in 5.6% of patients treated with transposition and 2.3% of patients treated with interposition. CONCLUSIONS Transposition presents similar results concerning short- and long-term patient satisfaction for treatment of TGN as well as similar numbers of complications of recurrences as interposition. Yet, current evidence is restricted to a few retrospective studies, thus, evidence is limited so far.
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Affiliation(s)
- Christian Uhl
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany -
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Park CK, Park BJ. Surgical treatment for Trigeminal neuralgia. J Korean Neurosurg Soc 2022; 65:615-621. [PMID: 35430788 PMCID: PMC9452382 DOI: 10.3340/jkns.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/16/2022] [Indexed: 11/27/2022] Open
Abstract
Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a low recurrence rate. Surgical treatment addresses the challenge of vascular compression, which accounts for 85% of the causes of TN. As for surgical treatment for TN, microvascular decompression (MVD) has become the surgical treatment of choice after Peter J. Jannetta reported the results of MVD surgery in 1996. Since then, many studies have reported a success rate of over 90% for the initial surgical treatment. Most MVDs aim to separate (decompress) the culprit vessel from the trigeminal nerve. To increase the success rate of surgery, accurate indications for MVD and management of the offender vessels without complications are critical. In addition, if there is no vascular compression, partial sensory rhizotomy or internal neurolysis can be performed to improve surgical outcomes.
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Sun T, Wang W, Huang Q, He L, Su Y, Li N, Liu J, Yang C. Teflon Granuloma: A Common Cause of Recurrent Trigeminal Neuralgia. World Neurosurg 2022; 158:e612-e617. [PMID: 34793993 DOI: 10.1016/j.wneu.2021.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/08/2022]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a common pain syndrome of the nervous system,. Although about 90% patients who were refractory to medications could be free from pain after microvascular decompression (MVD), some patients did experience recurrence. The study aimed to analyze clinical characteristics of patients with recurrent TN, recurrence factors of TN, and prognosis after re-do MVD. METHODS Clinical data and at least 12 months follow-up of patients with recurrent TN who underwent re-do MVD in our hospital from 2005 to 2020 were collected and analyzed. RESULTS A total of 14 patients with recurrent TN were enrolled eventually; adhesive arachnoid membranes were found in all patients. Teflon granuloma was found in 10 patients, new neurovascular compression (NVC) in 3 patients, and vascular displacement in 1 patient. Pain disappeared in 12 patients and relieved in 2 patients, but 4 patients experienced mild facial numbness and 1 patient suffered from incision infection after re-do MVC. No serious surgery-related complications and pain recurrences were recorded. CONCLUSIONS Teflon granuloma was the most common cause of TN recurrence in current study, new NVC was also saw in some patients. Patients with recurrent TN could get satisfactory results from re-do MVD.
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Affiliation(s)
- Tao Sun
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wentao Wang
- First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Qinghao Huang
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Longshuang He
- First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yu Su
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ning Li
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinlong Liu
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chao Yang
- First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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