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Open Access 01-12-2021 | Magnetic Resonance Imaging | Original Article - Functional Neurosurgery - Pain

Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned

Authors: Johannes Herta, Tobias Schmied, Theresa Bettina Loidl, Wei-te Wang, Wolfgang Marik, Fabian Winter, Matthias Tomschik, Heber Ferraz-Leite, Karl Rössler, Christian Dorfer

Published in: Acta Neurochirurgica | Issue 12/2021

Abstract

Objective

To analyze characteristics associated with long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TGN). Description of associated morbidity and complication avoidance.

Methods

One hundred sixty-five patients with TGN underwent 171 MVD surgeries at the authors’ institution. Patient characteristics and magnetic resonance imaging (MRI) datasets were obtained through the hospital’s archiving system. Patients provided information about pre- and post-operative pain characteristics and neurologic outcome. Favorable outcome was defined as a Barrow Neurological Institute (BNI) pain intensity score of I to III with post-operative improvement of I grade.

Results

Type of TGN pain with purely paroxysmal pain (p = 0.0202*) and TGN classification with classical TGN (p = 0.0372*) were the only significant predictors for long-term pain relief. Immediate pain relief occurred in 90.6% of patients with a recurrence rate of 39.4% after 3.5 ± 4.6 years. MRI reporting of a neurovascular conflict had a low negative predictive value of 39.6%. Mortality was 0% with major complications observed in 8.2% of patients. Older age was associated with lower complication rates (p = 0.0009***). Re-MVD surgeries showed improved long-term pain relief in four out of five cases.

Conclusions

MVD is a safe and effective procedure even in the elderly. It has the unique potential to cure TGN if performed on a regular basis, and if key surgical steps are respected. Early MVD should be offered in case of medical treatment failure and paroxysmal pain symptoms. The presence of a neurovascular conflict on MRI is not mandatory. In case of recurrence, re-MVD is a good treatment option that should be discussed with patients.

Highlights

• Long-term analysis of pain relief after MVD.

• Positive predictors for outcome: classical TGN and purely paroxysmal pain.

• Presence of neurovascular conflict in MRI is not mandatory for MVD surgery.

• Analysis of complications and surgical nuances for avoidance.

• MVD is a safe procedure also in the elderly.

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Title: Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned
Authors: Johannes Herta
Tobias Schmied
Theresa Bettina Loidl
Wei-te Wang
Wolfgang Marik
Fabian Winter
Matthias Tomschik
Heber Ferraz-Leite
Karl Rössler
Christian Dorfer
Publication date: 01-12-2021
Publisher: Springer Vienna
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Trigeminal Neuralgia
Published in: Acta Neurochirurgica / Issue 12/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-05028-2

At a glance: The STEP trials

Springer Medicine

Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned

Abstract

Objective

Methods

Results

Conclusions

Highlights

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Highlights

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