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Acta Neurochirurgica

Published in:

01-12-2010 | Clinical Article

Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia

Authors: Jørgen Degn, Jannick Brennum

Published in: Acta Neurochirurgica | Issue 12/2010

Abstract

Purpose

The study aims to assess the efficacy and safety of surgical treatment of trigeminal neuralgia (TN) in our department and to identify prognostic factors.

Methods

Seventy patients receiving surgical treatment for TN during the period 2003–2004 were included in this retrospective study. The surgical procedures used were glycerol injection (GI), microvascular decompression (MVD), or rhizotomia (RIZ). All patients were divided into spontaneous onset TN type1 (brief lancinating pain) or TN type 2 (continuous pain component). Two patients had bilateral TN; each side was regarded as a separate case. These 70 patients had a total of 160 interventions (110 GI, 40 MVD, and ten RIZ) performed in the period 1998–2007. Data were obtained by chart review and telephone interview. Patients provided information about pre- and postoperative pain characteristics including subtype, duration, intensity, and the use of antiepileptic drugs. Outcome was evaluated using a pain vector diagram.

Results

To quantify self-reported pain, we developed a new vector-based pain diagram. The subtype of TN was shown to be a very important prognostic factor. One year after MVD, 90% of patients with type 1 TN still had positive effect, whereas this was only true in 73% of patients with type 2 TN. After RIZ, the results were 71% and 33% for types 1 and 2, respectively. For comparison, GI had a significant lower effect but if the treatment led to hypoesthesia, 41% continued to have a positive effect 1 year after surgery, compared to only 24% if postoperative sensation was normal. Type 2 TN was found to be dominated by women with left-sided TN outside the V2 dermatome and with a lower probability of a neurovascular conflict. As expected, 1/5 of the cases developed postoperative hypoesthesia in the face following a nerve destructive procedure (RIZ and GI). Using MVD, the risk of serious side effects was about 4%. Complementary and alternative treatment had no general or permanent effect in the investigated population—quite the contrary.

Conclusions

Regarding prognosis and outcome, we find that it is very important to classify TN in subgroups (types 1 and 2). Dealing with medically treatment-resistant type 1 TN, MVD and RIZ are reasonably safe and effective interventions. The surgical results dealing with type 2 TN are still very poor. All patients with medically treatment-resistant TN should be offered referral to a neurosurgical unit with experience in treating this painful disease. We recommend using a vector-based pain diagram when evaluating the outcome of multiple interventions.

Ashkan K, Marsh H (2004) Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55(4):840–848CrossRefPubMed

Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334(17):1077–1083CrossRefPubMed

Bederson JB, Wilson CB (1989) Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71(3):359–367CrossRefPubMed

Bergenheim AT, Hariz MI, Laitinen LV, Olivecrona M, Rabow L (1991) Relation between sensory disturbance and outcome after retrogasserian glycerol rhizotomy. Acta Neurochir (Wien) 111(3–4):114–118CrossRef

Broggi G, Ferroli P, Franzini A, Servello D, Dones I (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68(1):59–64CrossRefPubMed

Burchiel KJ (2003) A new classification for facial pain. Neurosurgery 53(5):1164–1167CrossRefPubMed

Burchiel KJ, Slavin KV (2000) On the natural history of trigeminal neuralgia. Neurosurgery 46(1):152–154CrossRefPubMed

Carrazana E, Mikoshiba I (2003) Rationale and evidence for the use of oxcarbazepine in neuropathic pain. J Pain Symptom Manage 25(5S):S31–S35CrossRefPubMed

Chan LL, Ng KM, Fook-Chong S, Lo YL, Tan EK (2009) Three-dimensional MR volumetric analysis of the posterior fossa CSF space in hemifascial spasm. Neurology 73(13):1054–1057CrossRefPubMed

10.

Devor M, Amir R, Rappaport ZH (2002) Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 18(1):4–13CrossRefPubMed

11.

Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y (2009) Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. J Neurosurg 111(2):351–358CrossRefPubMed

12.

Dvorak T, Finn A, Price LL, Mignano JE, Fitzek MM, Wu JK, Yao KC (2009) Retreatment of trigeminal neuralgia with Gamma Knife radiosurgery: is there an appropriate cumulative dose? J Neurosurg 111(2):359–364CrossRefPubMed

13.

Fujimaki T, Fukushima T, Miyazaki S (1990) Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results. J Neurosurg 73(2):212–216CrossRefPubMed

14.

Han I, Shin D, Chang J, Kim K, Chang J, Huh R, Chung S (2010) Effect of various surgical modalities in recurrent or persistent trigeminal neuralgia. Stereotact Funct Neurosurg 88(3):156–162CrossRefPubMed

15.

Henderson LA, Gandevia SC, Macefield VG (2008) Gender differences in brain activity evoked by muscle and cutaneous pain: a retrospective study of single-trial fMRI data. Neuroimage 39(4):1867–1876CrossRefPubMed

16.

Henson CF, Goldman HW, Rosenwasser RH, Downes MB, Bednarz G, Pequignot EC, Werner-Wasik M, Curran WJ, Andrews DW (2005) Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: an analysis of patients treated at one institution. Int J Radiat Oncol Biol Phys 63(1):82–90CrossRefPubMed

17.

Jennings PA, Cameron P, Bernard S (2009) Measuring acute pain in the prehospital setting. Emerg Med J 26(8):552–555CrossRefPubMed

18.

Kabatas S, Albayrak SB, Cansever T, Hepgul KT (2009) Microvascular decompression as a surgical management for trigeminal neuralgia: a critical review of the literature. Neurol India 57(2):134–138CrossRefPubMed

19.

Kabatas S, Karasu A, Civelek E, Sabanci AP, Hepgul KT, Teng YD (2009) Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature. Neurosurg Rev 32(1):87–94CrossRefPubMed

20.

Kanpolat Y, Ugur HC (2005) Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 57(3):E601CrossRefPubMed

21.

Kobata H, Kondo A, Iwasaki K, Nishioka T (1998) Combined hyperactive dysfunction syndrome of the cranial nerves: trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: 11-year experience and review. Neurosurgery 43(6):1351–1361CrossRefPubMed

22.

Kondo A (1997) Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery 40(1):46–51CrossRefPubMed

23.

Lopez BC, Hamlyn PJ, Zakrzewska JM (2004) Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 54(4):973–982CrossRefPubMed

24.

McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90(1):1–8CrossRefPubMed

25.

Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G (2002) Acupuncture for idiopathic headache. Cochrane Database Syst Rev 1:CD001218

26.

Miller JP, Acar F, Burchiel KJ (2009) Classification of trigeminal neuralgia: clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression. J Neurosurg 111:1231–1234CrossRefPubMed

27.

Miller JP, Magill ST, Acar F, Burchiel KJ (2009) Predictors of long-term success after microvascular decompression for trigeminal neuralgia. J Neurosurg 110(4):620–626CrossRefPubMed

28.

Oturai AB, Jensen K, Eriksen J, Madsen FF (1998) Neurosurgical treatment of trigeminal neuralgia. A comparative study of alcohol block, neurectomy and electrocoagulation. Ugeskr Laeger 160(26):3909–3912PubMed

29.

Pandia MP, Dash HH, Bithal PK, Chouhan RS, Jain V (2008) Does egress of cerebrospinal fluid during percutaneous retrogasserian glycerol rhizotomy influence long term pain relief? Reg Anesth Pain Med 33(3):222–226PubMed

30.

Pickett GE, Bisnaire D, Ferguson GG (2005) Percutaneous retrogasserian glycerol rhizotomy in the treatment of tic douloureux associated with multiple sclerosis. Neurosurgery 56(3):537–545CrossRefPubMed

31.

Sandell T, Eide PK (2008) Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery 63(1):93–100CrossRefPubMed

32.

Sindou M, Acevedo G (2001) Microvascular decompression of the trigeminal nerve. Oper Tech Neurosurg 4(3):110–126CrossRef

33.

Sindou M, Chiha M, Mertens P (1995) Anatomical findings in microsurgical vascular decompression for trigeminal neuralgia. Correlations between topography of pain and site of the neuro-vascular conflict. Acta Neurochir Suppl 64:125–127PubMed

34.

Sindou M, Leston J, Decullier E, Chapuis F (2007) Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107(6):1144–1153CrossRefPubMed

35.

Skirving DJ, Dan NG (2001) A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 94(6):913–917CrossRefPubMed

36.

Szapiro J, Sindou M, Szapiro J (1985) Prognostic factors in microvascular decompression for trigeminal neuralgia. Neurosurgery 17(6):920–929CrossRefPubMed

37.

Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 150(3):243–255CrossRef

38.

Tronnier VM, Rasche D, Hamer J, Kienle AL, Kunze S (2001) Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48(6):1261–1267CrossRefPubMed

39.

Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, Chang YF (2002) Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96(3):527–531CrossRefPubMed

40.

Zakrzewska JM, Lopez BC (2003) Quality of reporting in evaluations of surgical treatment of trigeminal neuralgia: recommendations for future reports. Neurosurgery 53(1):110–120, discussion 120–2CrossRefPubMed

41.

Zakrzewska JM, Lopez BC, Kim SE, Varian EA, Coakham HB (2005) Patient satisfaction after surgery for trigeminal neuralgia—development of a questionnaire. Acta Neurochir (Wien) 147(9):925–932CrossRef

42.

Zhou CS, Kong DQ, Han ZY (2007) Clinical observation on acupoint injection of VitB12 for treatment of trigeminal neuralgia. Zhongguo Zhen Jiu 27(9):668–670PubMed

Title: Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia
Authors: Jørgen Degn
Jannick Brennum
Publication date: 01-12-2010
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 12/2010
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-010-0840-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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