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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

      52,235 Monthly downloads/views I 2.832 Impact Factor I 4.5 CiteScore I 1.2 Source Normalized Impact per Paper (SNIP) I 0.655 Scimago Journal & Country Rank (SJR)

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      Value of Partial Sensory Rhizotomy in the Microsurgical Treatment of Trigeminal Neuralgia Through Retrosigmoid Approach

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          Abstract

          Purpose

          Microvascular decompression (MVD) is the most effective surgical procedure for the treatment of refractory primary trigeminal neuralgia (TN), but due to the presence of non-neurovascular compression (NVC), the application of MVD is limited. In some cases, partial sensory rhizotomy (PSR) is required. The purpose of this study was to compare the outcome of MVD and MVD+PSR in the treatment of primary TN and to evaluate the application value of PSR in the treatment of TN.

          Patients and Methods

          We retrospectively analyzed the postoperative outcomes of patients who received MVD or MVD+PSR for the first time from the same surgeon in the neurosurgery department of China-Japan Friendship Hospital from March 2009 to December 2017. A total of 105 patients were included in the data analysis, including 40 in the MVD group and 65 in the MVD+PSR group.

          Results

          The MVD group had an effectiveness rate of 60% and a recurrence rate of 31.4% after an average follow-up of 49.4 months. The MVD+PSR group had an average effectiveness rate of 69.2% and a recurrence rate of 28.6% after an average follow-up of 71.4 months. There was no statistically significant intergroup difference in long-term effectiveness (p=0.333) or recurrence rates (p=0.819). The incidence of facial numbness was significantly higher in the MVD+PSR group than in the MVD group (83.1% vs 7.5%; p<0.001). However, facial numbness had no significant effect on the patients’ daily life.

          Conclusion

          MVD+PSR and MVD have the same effectiveness in the treatment of primary TN. MVD+PSR is associated with a higher incidence of facial numbness than MVD, but the difference does not affect the patients’ daily life. PSR should have a place in the treatment of TN by posterior fossa microsurgery.

          Most cited references23

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          The long-term outcome of microvascular decompression for trigeminal neuralgia.

          F G Barker, P J Jannetta, D Bissonette … (1996)
          Several surgical procedures to treat trigeminal neuralgia (tic douloureux) are available, but most reports provide only short-term follow-up information. We describe the long-term results of surgery in 1185 patients who underwent microvascular decompression of the trigeminal nerve for medically intractable trigeminal neuralgia. The outcome of the procedure was assessed prospectively with annual questionnaires. Of the 1185 patients who underwent microvascular decompression during the 20-year study period, 1155 were followed for 1 year or more after the operation. The median follow-up period was 6.2 years. Most postoperative recurrences of tic took place in the first two years after surgery. Thirty percent of the patients had recurrences of tic during the study period, and 11 percent underwent second operations for the recurrences. Ten years after surgery, 70 percent of the patients (as determined by Kaplan-Meier analysis) had excellent final results-that is, they were free of pain without medication for tic. An additional 4 percent had occasional pain that did not require long-term medication. Ten years after the procedure, the annual rate of the recurrence of tic was less than 1 percent. Female sex, symptoms lasting more than eight years, venous compression of the trigeminal-root entry zone, and the lack of immediate postoperative cessation of tic were significant predictors of eventual recurrence. Having undergone a previous ablative procedure did not lessen a patient's likelihood of having a cessation of tic after microvascular decompression, but the rates of burning and aching facial pain, as reported on the last follow-up questionnaire, were higher if a trigeminal-ganglion lesion had been created with radiofrequency current before microvascular decompression. Major complications included two deaths shortly after the operation (0.2 percent) and one brain-stem infarction (0.1 percent). Sixteen patients (1 percent) had ipsilateral hearing loss. Microvascular decompression is a safe and effective treatment for trigeminal neuralgia, with a high rate of long-term success.
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            Trigeminal neuralgia

            Giorgio Cruccu, Nanna B Finnerup, Troels Jensen … (2016)
            Trigeminal neuralgia (TN) is an exemplary condition of neuropathic facial pain. However, formally classifying TN as neuropathic pain based on the grading system of the International Association for the Study of Pain is complicated by the requirement of objective signs confirming an underlying lesion or disease of the somatosensory system. The latest version of the International Classification of Headache Disorders created similar difficulties by abandoning the term symptomatic TN for manifestations caused by major neurologic disease, such as tumors or multiple sclerosis. These diagnostic challenges hinder the triage of TN patients for therapy and clinical trials, and hamper the design of treatment guidelines. In response to these shortcomings, we have developed a classification of TN that aligns with the nosology of other neurologic disorders and neuropathic pain. We propose 3 diagnostic categories. Classical TN requires demonstration of morphologic changes in the trigeminal nerve root from vascular compression. Secondary TN is due to an identifiable underlying neurologic disease. TN of unknown etiology is labeled idiopathic. Diagnostic certainty is graded possible when pain paroxysms occur in the distribution of the trigeminal nerve branches. Triggered paroxysms permit the designation of clinically established TN and probable neuropathic pain. Imaging and neurophysiologic tests that establish the etiology of classical or secondary TN determine definite neuropathic pain.
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              Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute

              C.Leland Rogers, Andrew G Shetter, Jeffrey A. Fiedler … (2000)
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pain Res
                Journal ID (iso-abbrev): J Pain Res
                Journal ID (publisher-id): jpr
                Journal ID (pmc): jpainres
                Title: Journal of Pain Research
                Publisher: Dove
                ISSN (Electronic): 1178-7090
                Publication date (Electronic): 01 December 2020
                Publication date Collection: 2020
                Volume: 13
                Pages: 3207-3215
                Affiliations
                [1 ]Graduate School of Peking University Health Science Center , Beijing, People’s Republic of China
                [2 ]Department of Neurosurgery, China-Japan Friendship Hospital , Beijing, People’s Republic of China
                [3 ]Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing, People’s Republic of China
                Author notes
                Correspondence: Li ZhangDepartment of Neurosurgery, China-Japan Friendship Hospital , No. 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, People’s Republic of ChinaTel +86 18910586699Fax +86-10-64217749 Email allan18910586699@163.com
                Author information
                http://orcid.org/0000-0002-3871-8005
                http://orcid.org/0000-0003-1594-2968
                Article
                Publisher ID: 279674
                DOI: 10.2147/JPR.S279674
                PMC ID: 7720891
                SO-VID: 4ae89fe8-8fde-4f96-a0f7-abdddf2bad4b
                Copyright © © 2020 Liu et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 31 August 2020
                Date accepted : 30 October 2020
                Page count
                Figures: 3, Tables: 10, References: 23, Pages: 9
                Funding
                Funded by: received;
                No funding was received for this research.
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: trigeminal neuralgia,microvascular decompression,partial sensory rhizotomy,posterior fossa microsurgery
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: trigeminal neuralgia, microvascular decompression, partial sensory rhizotomy, posterior fossa microsurgery

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