DOI QR코드

DOI QR Code

Long Time Efficacy and Safety of Microvascular Decompression Combined with Internal Neurolysis for Recurrent Trigeminal Neuralgia

  • Zheng, Wenhao (The Fourth Clinical Medical College, Zhejiang Chinese Medical University) ;
  • Dong, Xiaoqiao (Department of Neurosurgery, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine) ;
  • Wang, Din (Department of Neurosurgery, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine) ;
  • Hu, Qiang (Department of Neurosurgery, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine) ;
  • Du, Quan (Department of Neurosurgery, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine)
  • Received : 2020.11.09
  • Accepted : 2021.03.26
  • Published : 2021.11.01

Abstract

Objective : To explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD. Methods : Sixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed. Results : The efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18-36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05). Conclusion : A retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of long-term facial numbness and other complications.

Keywords

References

  1. Bakker NA, Van Dijk JM, Immenga S, Wagemakers M, Metzemaekers JD : Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia. J Neurosurg 121 : 936-939, 2014 https://doi.org/10.3171/2014.7.JNS132667
  2. Cheng J, Meng J, Lei D, Hui X : Repeat microvascular decompression for patients with persistent or recurrent trigeminal neuralgia: prognostic factors and long-term outcomes. Medicine (Baltimore) 98 : e15167, 2019 https://doi.org/10.1097/md.0000000000015167
  3. Deng Z, Liu R, Liu Y, Wang Z, Yu Y, Zhang L : Factors that may affect delayed relief of trigeminal neuralgia after microneurosurgery and the long-term outcomes associated with delayed relief. J Pain Res 12 : 2817-2823, 2019 https://doi.org/10.2147/JPR.S222467
  4. Feng BH, Wang XH, Li ST : Posterior fossa re-exploration for recurrent trigeminal neuralgia: operative findings and surgical techniques. J Craniofac Surg 29 : 1284-1286, 2018 https://doi.org/10.1097/SCS.0000000000004576
  5. Gu W, Zhao W : Microvascular decompression for recurrent trigeminal neuralgia. J Clin Neurosci 21 : 1549-1553, 2014 https://doi.org/10.1016/j.jocn.2013.11.042
  6. Hussain MA, Konteas A, Sunderland G, Franceschini P, Byrne P, OsmanFarah J, et al. : Re-exploration of microvascular decompression in recurrent trigeminal neuralgia and intraoperative management options. World Neurosurg 117 : e67-e74, 2018 https://doi.org/10.1016/j.wneu.2018.05.147
  7. Jannetta PJ : Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26 Suppl : 159-162, 1967 https://doi.org/10.3171/jns.1967.26.1part2.0159
  8. Jie H, Xuanchen Z, Deheng L, Kun G, Fengyang X, Xiang C, et al. : The long-term outcome of nerve combing for trigeminal neuralgia. Acta Neurochir (Wien) 155 : 1703-1708; discussion 1707, 2013 https://doi.org/10.1007/s00701-013-1804-z
  9. Kakizawa Y, Seguchi T, Kodama K, Ogiwara T, Sasaki T, Goto T, et al. : Anatomical study of the trigeminal and facial cranial nerves with the aid of 3.0-tesla magnetic resonance imaging. J Neurosurg 108 : 483-490, 2008 https://doi.org/10.3171/JNS/2008/108/3/0483
  10. Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ : Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg 122 : 1048-1057, 2015 https://doi.org/10.3171/2014.12.JNS14469
  11. Liao C, Zhang W, Yang M, Zhong W, Liu P, Li S : Microvascular decompression for trigeminal neuralgia: the role of mechanical allodynia. World Neurosurg 91 : 468-472, 2016 https://doi.org/10.1016/j.wneu.2016.04.092
  12. Liu J, Wu G, Jiang Y, Li L, Wang D, Liu R : Relationship between arterial blood pressure during trigeminal nerve combing and surgical outcome in patients with trigeminal neuralgia. World Neurosurg 137 : e98-e105, 2020 https://doi.org/10.1016/j.wneu.2020.01.038
  13. Lu VM, Duvall JB, Phan K, Jonker BP : First treatment and retreatment of medically refractive trigeminal neuralgia by stereotactic radiosurgery versus microvascular decompression: a systematic review and metaanalysis. Br J Neurosurg 32 : 355-364, 2018 https://doi.org/10.1080/02688697.2018.1472213
  14. Patel SK, Liu JK : Overview and history of trigeminal neuralgia. Neurosurg Clin N Am 27 : 265-276, 2016 https://doi.org/10.1016/j.nec.2016.02.002
  15. Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL : Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47 : 1013-1019, 2000 https://doi.org/10.1016/S0360-3016(00)00513-7
  16. Sabourin V, Mazza J, Garzon T, Head J, Ye D, Stefanelli A, et al. : Internal neurolysis with and without microvascular decompression for trigeminal neuralgia: case series. World Neurosurg 143 : e70-e77, 2020 https://doi.org/10.1016/j.wneu.2020.06.206
  17. Siqueira SR, Teixeira MJ, Siqueira JT : Clinical characteristics of patients with trigeminal neuralgia referred to neurosurgery. Eur J Dent 2009 : 207-212, 2009
  18. Wu A, Doshi T, Hung A, Garzon-Muvdi T, Bender MT, Bettegowda C, et al. : Immediate and long-term outcomes of microvascular decompression for mixed trigeminal neuralgia. World Neurosurg 117 : e300-e307, 2018 https://doi.org/10.1016/j.wneu.2018.06.016
  19. Wu M, Jiang X, Niu C, Fu X : Outcome of internal neurolysis for trigeminal neuralgia without neurovascular compression and Its relationship with intraoperative trigeminocardiac reflex. Stereotact Funct Neurosurg 96 : 305-310, 2018 https://doi.org/10.1159/000493547
  20. Zhang X, Xu L, Zhao H, Tang YD, Zhu J, Yuan Y, et al. : Long-term efficacy of nerve combing for patients with trigeminal neuralgia and failed prior microvascular decompression. World Neurosurg 108 : 711-715, 2017 https://doi.org/10.1016/j.wneu.2017.09.081
  21. Zhao H, Zhang X, Tang D, Li S : Nerve combing for trigeminal neuralgia without vascular compression. J Craniofac Surg 28 : e15-e16, 2017 https://doi.org/10.1097/SCS.0000000000003161
  22. Zhong J, Li ST, Zhu J, Guan HX, Zhou QM, Jiao W, et al. : A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg 114 : 846-851, 2012 https://doi.org/10.1016/j.clineuro.2012.01.021