Personal experience with microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia
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Background: Trigeminal neuralgia (TN) is a severe, paroxysmal pain in the distribution of the fifth cranial nerve. Microvascular decompression (MVD) is the most widely used surgical treatment for TN. We undertook this study to analyze the effects of and complications of MVD and to refine the surgical procedure for treating TN. Methods: A total of 88 patients underwent for TN underwent surgery at our hospital. Among them, 77 patients underwent MVD alone, and 11 underwent partial sensory rhizotomy (PSR) with or without MVD. The medical records of these patients were retrospectively analyzed for patient characteristics, clinical results, offending vessels, and complications if any. Results: The mean follow-up duration was 43.2 months (range, 3–216 months). The most common site of pain was V2+V3 territory (n=27), followed by V2 (n=25) and V3 (n=23). The most common offending vessels were the superior cerebellar artery and anterior inferior cerebellar artery in that order. The overall rate of postoperative complications was 46.1%; however, most complications were transient. There were two cases of permanent partial hearing disturbance. In the MVD alone group, the cure rate was 67.5%, and the improvement rate was 26.0%. Among 11 patients who underwent PSR with or without MVD, the cure rate was 50.0%, and the improvement rate was 30.0%. Conclusion: The clinical results of MVD were satisfactory. Although the outcomes of PSR were not as favorable as those of pure MVD in this study, PSR can be considered in cases where there is no significant vascular compressive lesion or uncertainty of the causative vessel at the surgery.
Abstract
Background: Trigeminal neuralgia (TN) is a severe, paroxysmal pain in the distribution of the fifth cranial nerve. Microvascular decompression (MVD) is the most widely used surgical treatment for TN. We undertook this study to analyze the effects of and complications of MVD and to refine the surgical procedure for treating TN. Methods: A total of 88 patients underwent for TN underwent surgery at our hospital. Among them, 77 patients underwent MVD alone, and 11 underwent partial sensory rhizotomy (PSR) with or without MVD. The medical records of these patients were retrospectively analyzed for patient characteristics, clinical results, offending vessels, and complications if any. Results: The mean follow-up duration was 43.2 months (range, 3–216 months). The most common site of pain was V2+V3 territory (n=27), followed by V2 (n=25) and V3 (n=23). The most common offending vessels were the superior cerebellar artery and anterior inferior cerebellar artery in that order. The overall rate of postoperative complications was 46.1%; however, most complications were transient. There were two cases of permanent partial hearing disturbance. In the MVD alone group, the cure rate was 67.5%, and the improvement rate was 26.0%. Among 11 patients who underwent PSR with or without MVD, the cure rate was 50.0%, and the improvement rate was 30.0%. Conclusion: The clinical results of MVD were satisfactory. Although the outcomes of PSR were not as favorable as those of pure MVD in this study, PSR can be considered in cases where there is no significant vascular compressive lesion or uncertainty of the causative vessel at the surgery.
참고문헌 (26)
- Il Ho Kang, "A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment", 대한신경외과학회지, 59(6), pp.637~642 (2016), 대한신경외과학회
- Zhang L, "Surgical treatment of primary trigeminal neuralgia : comparison of the effectiveness between MVD and MVD+PSR in a series of 210 patients", Turk Neurosurg, 22, pp.32~38 (2012)
- Gao J, "Efficacy and prognostic value of partial sensory rhizotomy and microvascular decompression for primary trigeminal neuralgia : a comparative study", Med Sci Monit, 23, pp.2284~2291 (2017)
- Klun B, "Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia : personal experience with 220 patients", Neurosurgery, 30, pp.49~52 (1992)
- Bederson JB, "Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia", J Neurosurg, 71, pp.359~367 (1989)
- Frazier CH, "Trigeminal neuralgia : fourteen years experience with fractional section of the sensory root as the major operation", JAMA, 89, pp.1742~1744 (1927)
- 김성훈, "삼차신경통에 대한 미세혈관감압술의 효과", 대한신경외과학회지, 37(5), pp.357~363 (2005), 대한신경외과학회
- Rogers CL, "Gamma knife radiosurgery for trigeminal neuralgia : the initial experience of The Barrow Neurological Institute", Int J Radiat Oncol Biol Phys, 47, pp.1013~1019 (2000)
- Dandy WE, "Concerning the cause of trigeminal neuralgia", AM J Surg, 24, pp.447~455 (1934)
- Xia L, "Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia : a systematic review", J Craniofac Surg, 25, pp.1413~1417 (2014)
- Bond AE, "Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia", World Neurosurg, 74, pp.172~177 (2010)
- Ferroli P, "Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia : evidence of prejudice", Neurol Sci, 31, pp.23~28 (2010)
- Günther T, "Microvascular decompression for trigeminal neuralgia in the elderly : long-term treatment outcome and comparison with younger patients", Neurosurgery, 65, pp.477~482 (2009)
- Lee A, "Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression", J Neurosurg, 120, pp.1048~1054 (2014)
- Ishikawa M, "Operative findings in cases of trigeminal neuralgia without vascular compression : proposal of a different mechanism", J Clin Neurosci, 9, pp.200~204 (2002)
- Zhao H, "Nerve combing for trigeminal neuralgia without vascular compression", J Craniofac Surg, 28, pp.e15~e16 (2017)
- Toda K, "Operative treatment of trigeminal neuralgia : review of current techniques", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 106, pp.788~805 (2008)
- Abhinav K, "Clinicopathological review of patients with and without multiple sclerosis treated by partial sensory rhizotomy for medically refractory trigeminal neuralgia : a 12-year retrospective study", Clin Neurol Neurosurg, 114, pp.361~365 (2012)
- Koopman JS, "A nationwide study of three invasive treatments for trigeminal neuralgia", Pain, 152, pp.507~513 (2011)
- Liang X, "A retrospective study of neurocombing for the treatment of trigeminal neuralgia without neurovascular compression", Ir J Med Sci, 186, pp.1033~1039 (2017)
- Ko AL, "Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression", J Neurosurg, 122, pp.1048~1057 (2015)
- Zhong J, "Microvascular decompression surgery : surgical principles and technical nuances based on 4000 cases", Neurol Res, 36, pp.882~893 (2014)
- Oesman C, "Long-term follow-up of microvascular decompression for trigeminal neuralgia", Skull Base, 21, pp.313~322 (2011)
- Phan K, "Microvascular decompression for elderly patients with trigeminal neuralgia", J Clin Neurosci, 29, pp.7~14 (2016)
- Theodros D, "Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia", J Neurosurg, 126, pp.1691~1697 (2017)
- Mendoza N, "Trigeminal neuralgia treated by microvascular decompression : a long-term follow-up study", Br J Neurosurg, 9, pp.13~19 (1995)