Top

Acta Neurochirurgica

Published in:

Open Access 01-06-2021 | Trigeminal Neuralgia | Original Article - Functional Neurosurgery - Pain

Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors

Authors: Imran Noorani, Amanda Lodge, Andrew Durnford, Girish Vajramani, Owen Sparrow

Published in: Acta Neurochirurgica | Issue 6/2021

Abstract

Objective

Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD) and percutaneous procedures (glycerol rhizolysis; thermocoagulation; and balloon compression). Although the efficacy of each procedure has been documented, direct comparisons of their relative efficacies for TN are lacking. We aimed to directly compare long-term outcomes after first-time MVD with percutaneous surgery in primary (idiopathic and classical) TN and identify predictors of outcome.

Methods

We conducted a retrospective analysis of prospectively collected data on 185 patients undergoing MVD and 129 undergoing percutaneous surgery. Procedures were performed by one of two neurosurgeons in a single centre; an independent observer collected long-term follow-up data by interviews, using the same outcome measures for all procedures.

Results

MVD patients were younger than those undergoing percutaneous surgery (P <.001). MVD provided superior initial pain relief (P <.001): 87.0% had Barrow Neurological Institute class I or II pain scores after MVD compared with 67.2% after percutaneous surgery. The complication rate for percutaneous procedures was 35.7% and for MVDs was 24.9% (P =.04), including minor and transient complications. Kaplan-Meier analysis demonstrated that MVD provided longer pain relief than percutaneous procedures (P <.001); 25% of patients had recurrence at 96 months following MVD compared with 12 months after percutaneous surgery. Subgroup analysis showed that balloon compression provided more durable relief amongst percutaneous procedures. Multivariate analysis revealed that post-operative numbness and age were prognostic factors for percutaneous procedures (P =.03 and .01, respectively).

Conclusions

MVD provides better initial pain relief and longer durability of relief than percutaneous surgery, although carrying a small risk of major complications. Amongst percutaneous procedures, balloon compression gave the most durable relief from pain. Older age and post-operative numbness were predictors of good outcome from percutaneous surgery. These results can help clinicians to counsel patients with primary TN on neurosurgical treatment selection for pain relief.

Available only for authorised users

Ammori MB, King AT, Siripurapu R, Herwadkar AV, Rutherford SA (2013) Factors influencing decision-making and outcome in the surgical management of trigeminal neuralgia. J Neurol Surg B Skull Base 74:75–81. https://doi.org/10.1055/s-0033-1333617CrossRefPubMedPubMedCentral

Asplund P, Blomstedt P, Bergenheim AT (2016) Percutaneous balloon compression vs percutaneous retrogasserian glycerol rhizotomy for the primary treatment of trigeminal neuralgia. Neurosurgery 78:421–428; discussion 428. https://doi.org/10.1227/NEU.0000000000001059CrossRefPubMed

Asplund P, Linderoth B, Bergenheim AT (2010) The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia. J Neurosurg 113:498–507. https://doi.org/10.3171/2010.2.JNS091466CrossRefPubMed

Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083. https://doi.org/10.1056/NEJM199604253341701CrossRefPubMed

Bederson JB, Wilson CB (1989) Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71:359–367. https://doi.org/10.3171/jns.1989.71.3.0359CrossRefPubMed

Bender MT, Pradilla G, Batra S, See AP, James C, Pardo CA, Carson BS, Lim M (2013) Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis. J Neurosurg 118:329–336. https://doi.org/10.3171/2012.9.JNS1226CrossRefPubMed

Broggi G, Franzini A, Lasio G, Giorgi C, Servello D (1990) Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients. Neurosurgery 26:783–786 discussion 786-787CrossRef

Burchiel KJ (2003) A new classification for facial pain. Neurosurgery 53:1164–1166 discussion 1166-1167CrossRef

Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T (2016) Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 87:220–228. https://doi.org/10.1212/WNL.0000000000002840CrossRefPubMedPubMedCentral

10.

DeSouza DD, Hodaie M, Davis KD (2016) Structural magnetic resonance imaging can identify trigeminal system abnormalities in classical trigeminal neuralgia. Front Neuroanat 10:95. https://doi.org/10.3389/fnana.2016.00095CrossRefPubMedPubMedCentral

11.

Haines SJ, Jannetta PJ, Zorub DS (1980) Microvascular relations of the trigeminal nerve. An anatomical study with clinical correlation. J Neurosurg 52:381–386. https://doi.org/10.3171/jns.1980.52.3.0381CrossRefPubMed

12.

Hamlyn PJ, King TT (1992) Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:948–954. https://doi.org/10.3171/jns.1992.76.6.0948CrossRefPubMed

13.

Haridas A, Mathewson C, Eljamel S (2008) Long-term results of 405 refractory trigeminal neuralgia surgeries in 256 patients. Zentralbl Neurochir 69:170–174. https://doi.org/10.1055/s-2008-1077076CrossRefPubMed

14.

Heinskou TB, Rochat P, Maarbjerg S, Wolfram F, Brennum J, Olesen J, Bendtsen L (2019) Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: a prospective systematic study using independent assessors. Cephalalgia 39:197–208. https://doi.org/10.1177/0333102418783294CrossRefPubMed

15.

Hitchon PW, Holland M, Noeller J, Smith MC, Moritani T, Jerath N, He W (2016) Options in treating trigeminal neuralgia: experience with 195 patients. Clin Neurol Neurosurg 149:166–170. https://doi.org/10.1016/j.clineuro.2016.08.016CrossRefPubMed

16.

Holste K, Chan AY, Rolston JD, Englot DJ (2020) Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery 86:182–190. https://doi.org/10.1093/neuros/nyz075CrossRefPubMed

17.

Hughes MA, Jani RH, Fakhran S, Chang YF, Branstetter BF, Thirumala PD, Sekula RF (2019) Significance of degree of neurovascular compression in surgery for trigeminal neuralgia. J Neurosurg:1–6. https://doi.org/10.3171/2019.3.JNS183174

18.

Jannetta PJ, McLaughlin MR, Casey KF (2005) Technique of microvascular decompression. Technical note. Neurosurg Focus 18:E5PubMed

19.

Jellish WS, Benedict W, Owen K, Anderson D, Fluder E, Shea JF (2008) Perioperative and long-term operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation. Head Face Med 4:11. https://doi.org/10.1186/1746-160X-4-11CrossRefPubMedPubMedCentral

20.

Kanpolat Y, Savas A, Bekar A, Berk C (2001) Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery 48:524–532 discussion 532-524CrossRef

21.

Ko AL, Lee A, Raslan AM, Ozpinar A, McCartney S, Burchiel KJ (2015) Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression. J Neurosurg 123:1519–1527. https://doi.org/10.3171/2014.11.JNS141741CrossRefPubMed

22.

Kondziolka D, Lunsford LD, Flickinger JC (1998) Gamma knife radiosurgery as the first surgery for trigeminal neuralgia. Stereotact Funct Neurosurg 70(Suppl 1):187–191. https://doi.org/10.1159/000056421CrossRefPubMed

23.

Koopman JS, de Vries LM, Dieleman JP, Huygen FJ, Stricker BH, Sturkenboom MC (2011) A nationwide study of three invasive treatments for trigeminal neuralgia. Pain 152:507-513. doi:https://doi.org/10.1016/j.pain.2010.10.049

24.

Kouzounias K, Lind G, Schechtmann G, Winter J, Linderoth B (2010) Comparison of percutaneous balloon compression and glycerol rhizotomy for the treatment of trigeminal neuralgia. J Neurosurg 113:486–492. https://doi.org/10.3171/2010.1.JNS091106CrossRefPubMed

25.

Kouzounias K, Schechtmann G, Lind G, Winter J, Linderoth B (2010) Factors that influence outcome of percutaneous balloon compression in the treatment of trigeminal neuralgia. Neurosurgery 67:925–934; discussion 934. https://doi.org/10.1227/NEU.0b013e3181eb5230CrossRefPubMed

26.

Laghmari M, El Ouahabi A, Arkha Y, Derraz S, El Khamlichi A (2007) Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia? Surg Neurol 68:505-512. doi:https://doi.org/10.1016/j.surneu.2006.11.066

27.

Leal PR, Barbier C, Hermier M, Souza MA, Cristino-Filho G, Sindou M (2014) Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. J Neurosurg 120:1484–1495. https://doi.org/10.3171/2014.2.JNS131288CrossRefPubMed

28.

Lichtor T, Mullan JF (1990) A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion. J Neurosurg 72:49–54. https://doi.org/10.3171/jns.1990.72.1.0049CrossRefPubMed

29.

Liu Y, Li J, Butzkueven H, Duan Y, Zhang M, Shu N, Li Y, Zhang Y, Li K (2013) Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics. Eur J Radiol 82:783–786. https://doi.org/10.1016/j.ejrad.2012.11.027CrossRefPubMed

30.

Martin S, Teo M, Suttner N (2015) The effectiveness of percutaneous balloon compression in the treatment of trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg 123:1507–1511. https://doi.org/10.3171/2014.11.JNS14736CrossRefPubMed

31.

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 90:1–8. https://doi.org/10.3171/jns.1999.90.1.0001CrossRefPubMed

32.

Miller JP, Magill ST, Acar F, Burchiel KJ (2009) Predictors of long-term success after microvascular decompression for trigeminal neuralgia. J Neurosurg 110:620–626. https://doi.org/10.3171/2008.6.17605CrossRefPubMed

33.

Mullan S, Lichtor T (1983) Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia. J Neurosurg 59:1007–1012. https://doi.org/10.3171/jns.1983.59.6.1007CrossRefPubMed

34.

Noorani I, Lodge A, Vajramani G, Sparrow O (2016) Comparing percutaneous treatments of trigeminal neuralgia: 19 years of experience in a single centre. Stereotact Funct Neurosurg 94:75–85. https://doi.org/10.1159/000445077CrossRefPubMed

35.

Noorani I, Lodge A, Vajramani G, Sparrow O (2019) The effectiveness of percutaneous balloon compression, thermocoagulation, and glycerol rhizolysis for trigeminal neuralgia in multiple sclerosis. Neurosurgery 85:E684–E692. https://doi.org/10.1093/neuros/nyz103CrossRefPubMed

36.

North RB, Kidd DH, Piantadosi S, Carson BS (1990) Percutaneous retrogasserian glycerol rhizotomy. Predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 72:851–856. https://doi.org/10.3171/jns.1990.72.6.0851CrossRefPubMed

37.

Panczykowski DM, Jani RH, Hughes MA, Sekula RF (2019) Development and evaluation of a preoperative trigeminal neuralgia scoring system to predict long-term outcome following microvascular decompression. Neurosurgery. https://doi.org/10.1093/neuros/nyz376

38.

Pollock BE (2005) Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia. Neurosurg Focus 18:E6. https://doi.org/10.3171/foc.2005.18.5.7CrossRefPubMed

39.

Pollock BE, Schoeberl KA (2010) Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia. Neurosurgery 67:633–638; discussion 638-639. https://doi.org/10.1227/01.NEU.0000377861.14650.98CrossRefPubMed

40.

Ranganathan P, Pramesh CS, Aggarwal R (2017) Common pitfalls in statistical analysis: logistic regression. Perspect Clin Res 8:148–151. https://doi.org/10.4103/picr.PICR_87_17CrossRefPubMedPubMedCentral

41.

Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL (2000) Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47:1013–1019CrossRef

42.

Sarsam Z, Garcia-Finana M, Nurmikko TJ, Varma TR, Eldridge P (2010) The long-term outcome of microvascular decompression for trigeminal neuralgia. Br J Neurosurg 24:18–25. https://doi.org/10.3109/02688690903370289CrossRefPubMed

43.

Sindou M, Leston JM, Decullier E, Chapuis F (2008) Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique--Kaplan-Meier analysis in a consecutive series of 330 patients. Neurosurgery 63:341–350; discussion 350-341. https://doi.org/10.1227/01.NEU.0000327022.79171.D6CrossRefPubMed

44.

Skirving DJ, Dan NG (2001) A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 94:913–917. https://doi.org/10.3171/jns.2001.94.6.0913CrossRefPubMed

45.

Slavin KV, Nersesyan H, Colpan ME, Munawar N (2007) Current algorithm for the surgical treatment of facial pain. Head Face Med 3:30. https://doi.org/10.1186/1746-160X-3-30CrossRefPubMedPubMedCentral

46.

Sweet WH, Poletti CE, Macon JB (1981) Treatment of trigeminal neuralgia and other facial pains by retrogasserian injection of glycerol. Neurosurgery 9:647–653. https://doi.org/10.1227/00006123-198112000-00006CrossRefPubMed

47.

Taha JM, Tew JM Jr, Buncher CR (1995) A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 83:989–993. https://doi.org/10.3171/jns.1995.83.6.0989CrossRefPubMed

48.

Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir 150:243–255. https://doi.org/10.1007/s00701-007-1488-3CrossRefPubMed

49.

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 48:1261–1267 discussion 1267-1268PubMed

50.

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 96:527–531. https://doi.org/10.3171/jns.2002.96.3.0527CrossRefPubMed

51.

Udupi BP, Chouhan RS, Dash HH, Bithal PK, Prabhakar H (2012) Comparative evaluation of percutaneous retrogasserian glycerol rhizolysis and radiofrequency thermocoagulation techniques in the management of trigeminal neuralgia. Neurosurgery 70:407–412; discussion 412-403. https://doi.org/10.1227/NEU.0b013e318233a85fCrossRefPubMed

52.

Wang DD, Raygor KP, Cage TA, Ward MM, Westcott S, Barbaro NM, Chang EF (2018) Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J Neurosurg 128:68–77. https://doi.org/10.3171/2016.9.JNS16149CrossRefPubMed

53.

Zakrzewska JM, Akram H (2011) Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev:CD007312. doi:https://doi.org/10.1002/14651858.CD007312.pub2

Title: Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors
Authors: Imran Noorani
Amanda Lodge
Andrew Durnford
Girish Vajramani
Owen Sparrow
Publication date: 01-06-2021
Publisher: Springer Vienna
Keyword: Trigeminal Neuralgia
Published in: Acta Neurochirurgica / Issue 6/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-04793-4

At a glance: The STEP trials

Springer Medicine

Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2021

Endoscopic extra-capsular resection of a giant pituitary adenoma: how I do it

Spontaneous subdural haematoma in a neonate requiring urgent surgical evacuation

How I do it: Subtemporal transtentorial approach for cavernous malformation of the pons

The annular closure device - panacea of lumbar disc herniation: how closed is closed enough for the intervertebral disc space?

Feasibility of occipital condyle screw placement in patients with Chiari malformation type I: a computed tomography-based morphometric study

Diploic veins as collateral venous pathways in patients with dural venous sinus invasion by meningiomas