The outcomes of microvascular decompression for primary trigeminal neuralgia: insights from a single-center experience and technical advancements

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Abstract

Background

Microvascular decompression (MVD) remains the primary surgical treatment for trigeminal neuralgia due to its positive postoperative results. This study aims to evaluate the outcomes of patients with primary trigeminal neuralgia who underwent MVD. Additionally, the paper offers a detailed explanation of the surgical methodology of MVD employed at the neurosurgical hospital in Kazakhstan.

Methods

The study involved 165 medical records of patients with trigeminal neuralgia who underwent MVD between 2018 and 2020. Out of these 165 patients, 90 (54.55%) were included in the final analysis and were further evaluated using the Barrow Neurological Institute pain intensity score. Various variables were analyzed, including age, sex, affected side, dermatomes, offending vessel, and surgical intervention type. Moreover, the surgical technique employed at the hospital was described.

Results

The average follow-up period after the MVD procedure was 32.78 ± 9.91 months. The results indicated that out of the 90 patients, 80 (88.89%) achieved a good outcome as evidenced by BNI scores I and II. It was observed that patients with affected maxillary dermatomas and those with affected ophthalmic + maxillary dermatomas were more likely to experience fair + poor postsurgery BNI scores. On the other hand, patients with neurovascular conflicts involving the maxillary + mandibular dermatomas demonstrated good BNI scores ( p = 0.01).

Conclusions

The outcomes of MVD in patients with primary trigeminal neuralgia showed good BNI scores within this study population. The outcome depended on the affected dermatome of the trigeminal nerve with the vessel. Additionally, patient positioning, intraoperative management including small skin incisions, minimal craniotomy, and precise closure of the dura, as well as intraoperative neurolysis, may contribute to achieving good clinical and satisfactory post-surgery aesthetic outcomes.

Related collections

Most cited references 37

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European Academy of Neurology guideline on trigeminal neuralgia

L Bendtsen, J. Zakrzewska, J. Abbott … (2018)

Trigeminal neuralgia (TN) is an extremely painful condition which can be difficult to diagnose and treat. In Europe, TN patients are managed by many different specialities. Therefore, there is a great need for comprehensive European guidelines for the management of TN. The European Academy of Neurology asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with TN.

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AAN-EFNS guidelines on trigeminal neuralgia management.

G Cruccu, G. Gronseth, J Alksne … (2008)

Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence-based recommendations. In patients with TN MRI may be considered to identify patients with structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first-line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain.

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Author and article information

Contributors

Chingiz Nurimanov: URI : https://loop.frontiersin.org/people/2004988/overviewRole: Role: Role: Role: Role: Role: Role: Role: Role: Role:

Iroda Mammadinova: URI : https://loop.frontiersin.org/people/2178782/overviewRole: Role: Role: Role:

Karashash Menlibayeva: URI : https://loop.frontiersin.org/people/2668621/overviewRole: Role: Role: Role: Role:

Assylbek Kaliyev: URI : https://loop.frontiersin.org/people/2010157/overviewRole: Role: Role:

Yerbol Makhambetov: URI : https://loop.frontiersin.org/people/1749691/overviewRole: Role: Role: Role:

Serik Akshulakov: Role: Role: Role: Role:

Journal

Journal ID (nlm-ta): Front Surg

Journal ID (iso-abbrev): Front Surg

Journal ID (publisher-id): Front. Surg.

Title: Frontiers in Surgery

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-875X

Publication date (Electronic): 22 May 2024

Publication date Collection: 2024

Volume: 11

Electronic Location Identifier: 1378717

Affiliations

[ ¹ ]Vascular and Functional Neurosurgery Department, National Centre for Neurosurgery , Astana, Kazakhstan

[ ² ]Hospital Management Department, National Centre for Neurosurgery , Astana, Kazakhstan

Author notes

Edited by: Antonino Raco, Sapienza University of Rome, Italy

Reviewed by: Yoichi Uozumi, Kobe University, Japan

Kenichiro Kikuta, University of Fukui, Japan

[* ] Correspondence: Iroda Mammadinova irodamammadinova@ 123456gmail.com

Article

DOI: 10.3389/fsurg.2024.1378717

PMC ID: 11150634

PubMed ID: 38840974

SO-VID: cef2be82-d01f-4c46-bcfd-508520cc24f8

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 30 January 2024

Date accepted : 13 May 2024

Page count

Figures: 5, Tables: 2, Equations: 0, References: 38, Pages: 0, Words: 0

Funding

Funded by: National Centre for Neurosurgery

Award ID:

The author(s) declare financial support was received for the research, authorship, and/or publication of this article.

The Article Processing Charges are provided by the National Centre for Neurosurgery, Astana, Kazakhstan.

Custom metadata

section-at-acceptance Neurosurgery

Keywords: trigeminal neuralgia,neurovascular conflict,microvascular decompression,long-term outcomes,technical note

Data availability:

Keywords: trigeminal neuralgia, neurovascular conflict, microvascular decompression, long-term outcomes, technical note