IMMEDIATE PAIN RELIEF IN PATIENTS OF TRIGEMINAL NEUROLOGICAL AFTER MICROVASCULAR DECOMPRESSION (MVD)
Main Article Content
Keywords
Trigeminal neuralgia, microvascular decompression, immediate pain relief, surgical outcomes, precision surgery, revision MVD
Abstract
Introduction: Trigeminal neuralgia, characterized by intense facial pain, prompts surgical interventions when pharmaceutical options fail. Microvascular decompression (MVD) emerges as a preferred choice, yet nuances in immediate pain relief remain unexplored in existing literature.
Methodology: Conducted as a prospective observational study from July 2020 to July 2023, this research enrolled 50 trigeminal neuralgia patients slated for MVD. Comprehensive baseline data, preoperative assessments, meticulous documentation of surgical details, and structured follow-ups at 1, 6, and 12 months constituted the study design.
Results: Immediate postoperative outcomes revealed 60% complete relief, 30% partial relief, and 10% no relief. Age exhibited a robust correlation with outcomes, accentuating the need for age-tailored interventions. Surgical nuances, particularly revision MVD, correlated with higher recurrence rates, underscoring the importance of precision. Preoperative factors, especially multiple sclerosis, linked to lower relief rates, emphasizing the necessity for personalized, long-term follow-up.
Conclusion: This study provides crucial insights into MVD's immediate outcomes, emphasizing the imperative for precision in surgical approaches. The identified correlations offer avenues for refining protocols and enhancing the precision of pain relief in trigeminal neuralgia patients.
References
[2] Gardner WJ. RESPONSE OF TRIGEMINAL NEURALGIA TO “DECOMPRESSION” OF SENSORY ROOT. J Am Med Assoc 1959;170:1773. https://doi.org/10.1001/jama. 1959.03010150017004.
[3] Gardner WJ. Concerning the Mechanism of Trigeminal Neuralgia and Hemifacial Spasm. J Neurosurg 1962;19:947–58. https://doi.org/10.3171/jns.1962.19.11.0947.
[4] Hitchon PW, Holland M, Noeller J, Smith MC, Moritani T, Jerath N, et al. Options in treating trigeminal neuralgia: Experience with 195 patients. Clin Neurol Neurosurg 2016;149:166–70. https://doi.org/10.1016/j.clineuro.2016.08.016.
[5] Patankar AP, Chaudhary S, Patel K. Microvascular decompression for trigeminal neuralgia: an experience of 84 operated cases. Egyptian Journal of Neurosurgery 2023;38:71. https://doi.org/10.1186/s41984-023-00248-3.
[6] Dai Z-F, Huang Q, Liu H, Zhang wei. Efficacy of stereotactic gamma knife surgery and microvascular decompression in the treatment of primary trigeminal neuralgia: a retrospective study of 220 cases from a single center. J Pain Res 2016;Volume 9:535–42. https://doi.org/10.2147/JPR.S110161.
[7] Dieleman JP, Kerklaan J, Huygen FJPM, Bouma PAD, Sturkenboom MCJM. Incidence rates and treatment of neuropathic pain conditions in the general population ☆. Pain 2008;137:681–8. https://doi.org/10.1016/j.pain.2008.03.002.
[8] Hall GC, Carroll D, McQuay HJ. Primary care incidence and treatment of four neuropathic pain conditions: A descriptive study, 2002–2005. BMC Fam Pract 2008;9:26. https://doi.org/10.1186/1471-2296-9-26.
[9] Sharma R, Phalak M, Katiyar V, Borkar S, Kale S, Mahapatra A. Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta-analysis of prospective comparative trials. Neurol India 2018;66:688. https://doi.org/10.4103/0028-3886.232342.
[10] Sivakanthan S, Van Gompel JJ, Alikhani P, van Loveren H, Chen R, Agazzi S. Surgical Management of Trigeminal Neuralgia. Neurosurgery 2014;75:220–6. https://doi.org/10.1227/NEU.0000000000000430.
[11] Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019;26:831–49. https://doi.org/10.1111/ene.13950.
[12] Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020;19:784–96. https://doi.org/10.1016/S1474-4422(20)30233-7.
[13] Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol 2021;21:392–402. https://doi.org/10.1136/practneurol-2020-002782.
[14] Shi L, Gu X, Sun G, Guo J, Lin X, Zhang S, et al. After microvascular decompression to treat trigeminal neuralgia, both immediate pain relief and recurrence rates are higher in patients with arterial compression than with venous compression. Oncotarget 2017;8:44819–23. https://doi.org/10.18632/oncotarget.14765.
[15] Jannetta PJ. Operative techniques and clinicopathologic correlation in the surgical treatment of cranial rhizopathies (honored guest lecture). Clin Neurosurg 1997;44:181–95.
[16] Inoue T, Shima A, Hirai H, Suzuki F, Matsuda M. Trigeminal Neuralgia Due to Red Vein Draining a Supratentorial Arteriovenous Malformation: Case Report. J Neurol Surg Rep 2016;77:e109–12. https://doi.org/10.1055/s-0036-1584817.
[17] Zhao H, Tang Y, Zhang X, Li S. Microvascular Decompression for Idiopathic Primary Trigeminal Neuralgia in Patients Over 75 Years of Age. Journal of Craniofacial Surgery 2016;27:1295–7. https://doi.org/10.1097/SCS.0000000000002787.
[18] Loayza R, Wikström J, Grabowska A, Semnic R, Ericson H, Abu Hamdeh S. Outcome after microvascular decompression for trigeminal neuralgia in a single center—relation to sex and severity of neurovascular conflict. Acta Neurochir (Wien) 2023. https://doi.org/10.1007/s00701-023-05642-2.
[19] Amaya Pascasio L, De La Casa-Fages B, Esteban de Antonio E, Grandas F, García-Leal R, Ruiz Juretschke F. Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors. Neurología 2023;38:625–34. https://doi.org/10.1016/j.nrl.2021.03.009.
[20] Jagannath P, Venkataramana N, Bansal A, Ravichandra M. Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: A five-year prospective study. Asian J Neurosurg 2012;7:125–30. https://doi.org/10.4103/1793-5482.103713.
[21] Di Carlo DT, Benedetto N, Perrini P. Clinical outcome after microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev 2022;46:8. https://doi.org/10.1007/s10143-022-01922-0.
[22] Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smilkov EA, et al. Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients. J Headache Pain 2022;23:145. https://doi.org/10.1186/s10194-022-01520-x
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Muhammad Emaduddin Saad Mallick
F.C.P. S Neurosurgery, Consultant Neurosurgery, Ghouri Medical Center
Ummesalma M. Rehan
Assistant Professor of Surgery, Batterjee Medical College
Syed Rahat Hassan
Assistant Professor Surgery, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi
Gohar Ali
Assistant Professor of Neurosurgery, BKMC/MMC Mardan KPK
Muhammad Kashif
Associate Professor General Surgery, GKMC/BKMC, Swabi
Tahir Ali
Assistant Professor of Pharmacology, Meraki Institute of Medical Sciences, Takht Bhai Mardan