A novel scoring system as a preoperative predictor for pain-free survival after microsurgery for trigeminal neuralgia

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OBJECTIVE

Pain relief following microvascular decompression (MVD) for trigeminal neuralgia (TN) may be related to pain type, degree of neurovascular conflict, arterial compression, and location of compression. The objective of this study was to construct a predictive pain-free scoring system based on clinical and radiographic factors that can be used to preoperatively prognosticate long-term outcomes for TN patients following surgical intervention (MVD or internal neurolysis [IN]). It was hypothesized that contributing factors would include pain type, presence of an artery or vein, neurovascular conflict severity, and compression location (root entry zone).

METHODS

At the authors’ institution 275 patients with type 1 or type 2 TN (TN1 or TN2) underwent MVD or IN following preoperative high-resolution brain MRI studies. Outcome data were obtained retrospectively by chart review and/or phone follow-up. Characteristics of neurovascular conflict were obtained from preoperative MRI studies. Factors that resulted in a probability value of < 0.05 on univariate logistic regression analyses were entered into a multivariate Cox regression analysis in a backward stepwise fashion. For the multivariate analysis, significance at the 0.15 level was used. A prognostic system was then devised with 4 possible scores (0, 1, 2, or 3) and pain-free survival analyses conducted.

RESULTS

Univariate predictors of pain-free survival were pain type (p = 0.013), presence of any vessel (p = 0.042), and neurovascular compression severity (p = 0.038). Scores of 0, 1, 2, and 3 were found to be significantly different in regard to pain-free survival (log rank, p = 0.005). At 5 and 10 years there were 36%, 43%, 61%, and 69%, and 36%, 43%, 56%, and 67% pain-free survival rates in groups 0, 1, 2, and 3, respectively. While TN2 patients had worse outcomes regardless of score, a subgroup analysis of TN1 patients with higher neurovascular conflict (score of 3) had significantly better outcomes than TN1 patients without severe neurovascular conflict (score of 1) (log rank, p = 0.005). Regardless of pain type, those patients with severe neurovascular conflict were more likely to have arterial compression (99%) compared to those with low neurovascular conflict (p < 0.001).

CONCLUSIONS

Pain-free survival was predicted by a scoring system based on preoperative clinical and radiographic findings. Higher scores predicted significantly better pain relief than lower scores. TN1 patients with severe neurovascular conflict had the best long-term pain-free outcome.

ABBREVIATIONS IN = internal neurolysis; MVD = microvascular decompression; NVC = neurovascular compression; TN = trigeminal neuralgia; TN1 = type 1 TN; TN2 = type 2 TN; REZ = root entry zone; TOF = time of flight.

Article Information

Correspondence Ahmed M. Raslan: Oregon Health & Science University, Portland, OR. raslana@ohsu.edu.

INCLUDE WHEN CITING Published online January 25, 2019; DOI: 10.3171/2018.9.JNS181208.

Disclosures Dr. Raslan reports being a consultant for Abbott.

© AANS, except where prohibited by US copyright law.

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Figures

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    Patients with lower scores (1 and 0) had the highest proportion of IN-only procedures.

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    Examples of radiographic vascular compression subscores: grade I (A), grade II (B), and grade III (C).

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    Telephone interview questions.

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    Kaplan-Meier curve plotting composite score against pain-free survival (log rank, p = 0.005).

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    Kaplan-Meier curve plotting TN1 outcomes for patients with a score of 1 versus a score of 3 (log rank, p = 0.005).

References

  • 1

    Barker FG IIJannetta PJBissonette DJLarkins MVJho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:107710831996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bederson JBWilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71:3593671989

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Broggi GBroggi MFerroli PFranzini A: Surgical technique for trigeminal microvascular decompression. Acta Neurochir (Wien) 154:108910952012

  • 4

    Burchiel KJ: A new classification for facial pain. Neurosurgery 53:116411672003

  • 5

    Burchiel KJClarke HHaglund MLoeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:35381988

  • 6

    Chang EFSmith JSChang SMLamborn KRPrados MDButowski N: Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109:8178242008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Cohen JCohen PWest SAiken L: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciencesed 3. Mahwah, NJ: Lawrence Erlbaum Associates2003

    • Search Google Scholar
    • Export Citation
  • 8

    Jannetta PJ: Neurovascular compression in cranial nerve and systemic disease. Ann Surg 192:5185251980

  • 9

    Jie HXuanchen ZDeheng LKun GFengyang XXiang C: The long-term outcome of nerve combing for trigeminal neuralgia. Acta Neurochir (Wien) 155:170317082013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Jo KWKong DSHong KSLee JAPark K: Long-term prognostic factors for microvascular decompression for trigeminal neuralgia. J Clin Neurosci 20:4404452013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ko ALOzpinar ALee ARaslan AMMcCartney SBurchiel KJ: Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg 122:104810572015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Kulkarni AVDrake JMMallucci CLSgouros SRoth JConstantini S: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254259 259.e12009

    • Search Google Scholar
    • Export Citation
  • 13

    Leal PRHermier MFroment JCSouza MACristino-Filho GSindou M: Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 152:8178252010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Lee AMcCartney SBurbidge CRaslan AMBurchiel KJ: Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. J Neurosurg 120:104810542014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Li STPan QLiu NShen FLiu ZGuan Y: Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 62:4004052004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Maarbjerg SWolfram FGozalov AOlesen JBendtsen L: Significance of neurovascular contact in classical trigeminal neuralgia. Brain 138:3113192015

  • 17

    Miller JPMagill STAcar FBurchiel KJ: Predictors of long-term success after microvascular decompression for trigeminal neuralgia. J Neurosurg 110:6206262009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Sindou MHoweidy TAcevedo G: Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir (Wien) 144:1132002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Sindou MLeston JDecullier EChapuis F: Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107:114411532007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Tyler-Kabara ECKassam ABHorowitz MHUrgo LHadjipanayis CLevy EI: Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:5275312002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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