Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia.

Journal Article (Journal Article)

OBJECTIVE Trigeminal neuralgia (TN) is characterized by intermittent, paroxysmal, and lancinating pain along the distribution of the trigeminal nerve. Microvascular decompression (MVD) directly addresses compression of the trigeminal nerve. The purpose of this study was to determine whether patients undergoing MVD as their first surgical intervention experience greater pain control than patients who undergo subsequent MVD. METHODS A retrospective review of patient records from 1998 to 2015 identified a total of 942 patients with TN and 500 patients who underwent MVD. After excluding several cases, 306 patients underwent MVD as their first surgical intervention and 175 patients underwent subsequent MVD. Demographics and clinicopathological data and outcomes were obtained for analysis. RESULTS In patients who underwent subsequent MVD, surgical intervention was performed at an older age (55.22 vs 49.98 years old, p < 0.0001) and the duration of symptoms was greater (7.22 vs 4.45 years, p < 0.0001) than for patients in whom MVD was their first surgical intervention. Patients who underwent initial MVD had improved pain relief and no improvement in pain rates compared with those who had subsequent MVD (95.8% and 4.2% vs 90.3% and 9.7%, respectively, p = 0.0041). Patients who underwent initial MVD had significantly lower rates of facial numbness in the pre- and postoperative periods compared with patients who underwent subsequent MVD (p < 0.0001). The number of complications in both groups was similar (p = 0.4572). CONCLUSIONS The results demonstrate that patients who underwent other procedures prior to MVD had less pain relief and a higher incidence of facial numbness despite rates of complications similar to patients who underwent MVD as their first surgical intervention.

Full Text

Duke Authors

Cited Authors

  • Theodros, D; Rory Goodwin, C; Bender, MT; Zhou, X; Garzon-Muvdi, T; De la Garza-Ramos, R; Abu-Bonsrah, N; Mathios, D; Blitz, AM; Olivi, A; Carson, B; Bettegowda, C; Lim, M

Published Date

  • May 2017

Published In

Volume / Issue

  • 126 / 5

Start / End Page

  • 1691 - 1697

PubMed ID

  • 27419826

Electronic International Standard Serial Number (EISSN)

  • 1933-0693

Digital Object Identifier (DOI)

  • 10.3171/2016.5.JNS151692

Language

  • eng

Conference Location

  • United States