Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia

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OBJECTIVE

Trigeminal neuralgia (TN) is characterized by intermittent, paroxysmal, and lancinating pain along the distribution of the trigeminal nerve. Microvascular decompression (MVD) directly addresses compression of the trigeminal nerve. The purpose of this study was to determine whether patients undergoing MVD as their first surgical intervention experience greater pain control than patients who undergo subsequent MVD.

METHODS

A retrospective review of patient records from 1998 to 2015 identified a total of 942 patients with TN and 500 patients who underwent MVD. After excluding several cases, 306 patients underwent MVD as their first surgical intervention and 175 patients underwent subsequent MVD. Demographics and clinicopathological data and outcomes were obtained for analysis.

RESULTS

In patients who underwent subsequent MVD, surgical intervention was performed at an older age (55.22 vs 49.98 years old, p < 0.0001) and the duration of symptoms was greater (7.22 vs 4.45 years, p < 0.0001) than for patients in whom MVD was their first surgical intervention. Patients who underwent initial MVD had improved pain relief and no improvement in pain rates compared with those who had subsequent MVD (95.8% and 4.2% vs 90.3% and 9.7%, respectively, p = 0.0041).

Patients who underwent initial MVD had significantly lower rates of facial numbness in the pre- and postoperative periods compared with patients who underwent subsequent MVD (p < 0.0001). The number of complications in both groups was similar (p = 0.4572).

CONCLUSIONS

The results demonstrate that patients who underwent other procedures prior to MVD had less pain relief and a higher incidence of facial numbness despite rates of complications similar to patients who underwent MVD as their first surgical intervention.

ABBREVIATIONS CISS = constructive interference in steady-state; MVD = microvascular decompression; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online July 15, 2016; DOI: 10.3171/2016.5.JNS151692.Correspondence Michael Lim, Department of Neurosurgery, Johns Hopkins Hospital, 600 N Wolfe St., Phipps 123, Baltimore, MD 21287. email: mlim3@jhmi.edu.Disclosures Dr. Michael Lim is a consultant for Stryker. Dr. Goodwin is a UNCF Merck Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund. This article reflects the views of the authors and should not be construed to represent the FDA's views or policies.

© AANS, except where prohibited by US copyright law.

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