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microvascular_decompression_for_trigeminal_neuralgia

Microvascular decompression for trigeminal neuralgia

see also Microvascular decompression for trigeminal neuralgia and multiple sclerosis

Awake Microvascular Decompression for Trigeminal Neuralgia

see also Endoscope assisted microvascular decompression for trigeminal neuralgia.

Microvascular decompression is a first-line neurosurgical approach for classical trigeminal neuralgia with neurovascular conflict, but can show clinical relapse despite proper decompression. Second-line destructive techniques like radiofrequency thermocoagulation have become reluctantly used due to their potential for irreversible side effects. Subcutaneous peripheral nerve field stimulation (sPNFS) is a minimally invasive neuromodulatory technique which has been shown to be effective for chronic localised pain conditions.

The most frequently used surgical management of trigeminal neuralgia is Microvascular decompression (MVD), followed closely by stereotactic radiosurgery (SRS). Percutaneous stereotactic rhizotomy (PSR) , despite being the most cost-effective, is by far the least utilized treatment modality 1).

Microvascular decompression (MVD) via lateral suboccipital approach is the standard surgical intervention for trigeminal neuralgia treatment.

Teflon™ and Ivalon® are two materials used in MVD for TN. It is an effective treatment with long-term symptom relief and recurrence rates of 1-5% each year. Ivalon® has been used less than Teflon™ though is associated with similar success rates and similar complication rates 2)

Although microvascular decompression (MVD) is the most effective long-term operative treatment for TN, its use in older patient populations has been debated due to its invasive nature.


Compared with the standard microscope-assisted techniques, the 3D exoscopic endoscope-assisted MVD offers an improved visualisation without compromising the field of view within and outside the surgical field 3).

Outcome

It has proven to be the most successful and durable surgical approach for trigeminal neuralgia (TN).

However, not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence.

It does not achieve 100 % cure rate. Re-exploration of the posterior fossa may carry increased risk over first-time MVD and is not always successful, so other treatments are needed.


Age itself does not seem to represent a major contraindication of microvascular decompression for typical trigeminal neuralgia 4).

Patients 60 yr of age and older have significantly better long-term pain outcomes following MVD than younger patients 5).

Complications

Case series

References

1)
Sivakanthan S, Van Gompel JJ, Alikhani P, van Loveren H, Chen R, Agazzi S. Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the medicare claims database. Neurosurgery. 2014 Sep;75(3):220-6. doi: 10.1227/NEU.0000000000000430. PubMed PMID: 24871139.
2)
Pressman E, Jha RT, Zavadskiy G, Kumar JI, van Loveren H, van Gompel JJ, Agazzi S. Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia. Neurosurg Rev. 2019 Nov 30. doi: 10.1007/s10143-019-01187-0. [Epub ahead of print] Review. PubMed PMID: 31786660.
3)
Li Ching Ng A, Di Ieva A. How I do it: 3D exoscopic endoscope-assisted microvascular decompression. Acta Neurochir (Wien). 2019 May 29. doi: 10.1007/s00701-019-03954-w. [Epub ahead of print] PubMed PMID: 31144166.
4)
Mastronardi L, Caputi F, Rinaldi A, Cacciotti G, Roperto R, Scavo CG, Stati G, Sufianov A. Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Operated on with Microvascular Decompression by Retrosigmoid Approach. J Neurol Surg A Cent Eur Neurosurg. 2019 Aug 29. doi: 10.1055/s-0039-1693126. [Epub ahead of print] PubMed PMID: 31466107.
5)
Bick SK, Huie D, Sneh G, Eskandar EN. Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia. Neurosurgery. 2019 Jan 1;84(1):116-122. doi: 10.1093/neuros/nyy011. PubMed PMID: 29562363.
microvascular_decompression_for_trigeminal_neuralgia.txt · Last modified: 2019/12/10 13:52 by administrador