Predictors of long-term success after microvascular decompression for trigeminal neuralgia

Clinical article

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Object

Microvascular decompression (MVD) is an effective treatment for trigeminal neuralgia (TN). However, many patients do not experience complete pain relief, and relapse can occur even after an initial excellent result. This study was designed to identify characteristics associated with improved long-term outcome after MVD.

Methods

One hundred seventy-nine consecutive patients who had undergone MVD for TN at the authors' institution were contacted, and 95 were enrolled in the study. Patients provided information about preoperative pain characteristics including preponderance of shock-like (Type 1 TN) or constant (Type 2 TN) pain, preoperative duration, trigger points, anticonvulsant therapy response, memorable onset, and pain-free intervals. Three groups were defined based on outcome: 1) excellent, pain relief without medication; 2) good, mild or intermittent pain controlled with low-dose medication; and 3) poor, severe persistent pain or need for additional surgical treatment.

Results

Type of TN pain (Type 1 TN vs Type 2 TN) was the only significant predictor of outcome after MVD. Results were excellent, good, and poor for Type 1 TN versus Type 2 TN patients in 60 versus 25%, 24 versus 39%, and 16 versus 36%, respectively. Among patients with each TN type, there was a significant trend toward better outcome with greater proportional contribution of Type 1 TN (lancinating) symptoms (p < 0.05).

Conclusions

Pain relief after MVD is strongly correlated with the lancinating pain component, and therefore type of TN pain is the best predictor of long-term outcome after MVD. Application of this information should be helpful in the selection of TN patients likely to benefit from MVD.

Abbreviations used in this paper: AED = anticonvulsant drug; MVD = microvascular decompression; TN = trigeminal neuralgia.

Article Information

Address correspondence to: Kim J. Burchiel, M.D., Neurological Surgery, Mail Code: CH8N, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, Oregon 97239. email: burchiek@ohsu.edu.

Please include this information when citing this paper: published online February 20, 2009; DOI: 10.3171/2008.9.17660.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph of results based on Type of TN pain.

  • View in gallery

    Kaplan-Meier plots based on type of TN pain for pain relief (excellent outcome) (upper) and pain improvement (excellent or good outcome) (lower) in 67 patients with Type 1 and 28 patients with Type 2 TN. While relapses were common in both types, Type 1 TN was associated with significantly higher immediate and long-term improvement in pain.

  • View in gallery

    Graph of results based on proportional contribution of lancinating versus constant pain across both TN types.

References

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