Yeungnam Univ J Med.  2021 Jul;38(3):202-207. 10.12701/yujm.2020.00745.

Personal experience with microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia

Affiliations
  • 1Department of Neurosurgery, Pusan National University Hospital, Busan, Korea

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.

Keyword

Microvascular decompression surgery; Rhizotomy; Treatment outcome; Trigeminal neuralgia

Figure

  • Fig. 1. Intraoperative view of partial sensory rhizotomy in right-side approach. If there was no offending vessel in intraoperative findings (A), about half to two-thirds of trigeminal nerve sensory root (arrows) was cut off (B).


Reference

References

1. Kang IH, Park BJ, Park CK, Malla HP, Lee SH, Rhee BA. A clinical analysis of secondary surgery in trigeminal neuralgia patients who failed prior treatment. J Korean Neurosurg Soc. 2016; 59:637–42.
Article
2. Zhang L, Zhang Y, Li C, Zhu S. Surgical treatment of primary trigeminal neuralgia: comparison of the effectiveness between MVD and MVD+PSR in a series of 210 patients. Turk Neurosurg. 2012; 22:32–8.
Article
3. Gao J, Fu Y, Guo SK, Li B, Xu ZX. Efficacy and prognostic value of partial sensory rhizotomy and microvascular decompression for primary trigeminal neuralgia: a comparative study. Med Sci Monit. 2017; 23:2284–91.
Article
4. Klun B. Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery. 1992; 30:49–52.
Article
5. Bederson JB, Wilson CB. Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg. 1989; 71:359–67.
Article
6. Frazier CH. Trigeminal neuralgia: fourteen years experience with fractional section of the sensory root as the major operation. JAMA. 1927; 89:1742–4.
7. Kim SH, Choi CH. The efficacy of microvascular decompression for trigeminal neuralgia. J Korean Neurosurg Soc. 2005; 37:357–63.
8. 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. 2000; 47:1013–9.
Article
9. Dandy WE. Concerning the cause of trigeminal neuralgia. AM J Surg. 1934; 24:447–55.
Article
10. Xia L, Zhong J, Zhu J, Wang YN, Dou NN, Liu MX, et al. Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg. 2014; 25:1413–7.
11. Bond AE, Zada G, Gonzalez AA, Hansen C, Giannotta SL. Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia. World Neurosurg. 2010; 74:172–7.
Article
12. Ferroli P, Acerbi F, Tomei M, Tringali G, Franzini A, Broggi G. Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice? Neurol Sci. 2010; 31:23–8.
Article
13. Günther T, Gerganov VM, Stieglitz L, Ludemann W, Samii A, Samii M. Microvascular decompression for trigeminal neuralgia in the elderly: long-term treatment outcome and comparison with younger patients. Neurosurgery. 2009; 65:477–82.
14. Lee A, McCartney S, Burbidge C, Raslan AM, Burchiel KJ. Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. J Neurosurg. 2014; 120:1048–54.
Article
15. Ishikawa M, Nishi S, Aoki T, Takase T, Wada E, Ohwaki H, et al. Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism. J Clin Neurosci. 2002; 9:200–4.
Article
16. Zhao H, Zhang X, Tang D, Li S. Nerve combing for trigeminal neuralgia without vascular compression. J Craniofac Surg. 2017; 28:e15–6.
Article
17. Toda K. Operative treatment of trigeminal neuralgia: review of current techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:788–805. e1-6.
Article
18. Abhinav K, Love S, Kalantzis G, Coakham HB, Patel NK. 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. 2012; 114:361–5.
Article
19. Koopman JS, de Vries LM, Dieleman JP, Huygen FJ, Stricker BH, Sturkenboom MC. A nationwide study of three invasive treatments for trigeminal neuralgia. Pain. 2011; 152:507–13.
Article
20. Liang X, Dong X, Zhao S, Ying X, Du Y, Yu W. A retrospective study of neurocombing for the treatment of trigeminal neuralgia without neurovascular compression. Ir J Med Sci. 2017; 186:1033–9.
Article
21. 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. 2015; 122:1048–57.
Article
22. Zhong J, Zhu J, Sun H, Dou NN, Wang YN, Ying TT, et al. Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases. Neurol Res. 2014; 36:882–93.
Article
23. Oesman C, Mooij JJ. Long-term follow-up of microvascular decompression for trigeminal neuralgia. Skull Base. 2011; 21:313–22.
Article
24. Phan K, Rao PJ, Dexter M. Microvascular decompression for elderly patients with trigeminal neuralgia. J Clin Neurosci. 2016; 29:7–14.
Article
25. Theodros D, Rory Goodwin C, Bender MT, Zhou X, Garzon-Muvdi T, De la Garza-Ramos R, et al. Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia. J Neurosurg. 2017; 126:1691–7.
Article
26. Mendoza N, Illingworth RD. Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study. Br J Neurosurg. 1995; 9:13–9.
Article
Full Text Links
  • YUJM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr