M Tatli1, O Satici, Y Kanpolat, M Sindou. 1. Department of Neurosurgery, Hospital Neurologique Pierre Wertheimer Hospital, University of Lyon, Lyon, France. tatli.mehmet@gmail.com
Abstract
BACKGROUND: The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. METHOD: All studies that had a minimum 5 years or more (> or =5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student's t-test, Chi-square followed by Pearson's risk analysis tests were used. Kaplan-Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. FINDINGS: Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. CONCLUSIONS: The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.
BACKGROUND: The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. METHOD: All studies that had a minimum 5 years or more (> or =5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student's t-test, Chi-square followed by Pearson's risk analysis tests were used. Kaplan-Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. FINDINGS: Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. CONCLUSIONS: The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.
Authors: Kristine Ravina; Ben A Strickland; Robert C Rennert; Joshua Bakhsheshian; Jonathan J Russin; Steven L Giannotta Journal: J Neurol Surg B Skull Base Date: 2018-06-29
Authors: B G Northcutt; D P Seeburg; J Shin; N Aygun; D A Herzka; D Theodros; C R Goodwin; C Bettegowda; M Lim; A M Blitz Journal: AJNR Am J Neuroradiol Date: 2016-06-30 Impact factor: 3.825
Authors: Mark R Jones; Ivan Urits; Ken P Ehrhardt; John N Cefalu; Julia B Kendrick; Daniel J Park; Elyse M Cornett; Alan D Kaye; Omar Viswanath Journal: Curr Pain Headache Rep Date: 2019-08-06