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

View More View Less
  • 1 Departments of Neurological Surgery and
  • 2 Psychology, Oregon Health & Science University, Portland, Oregon
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

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.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

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.

  • 1

    Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:10771083, 1996

    • Search Google Scholar
    • Export Citation
  • 2

    Bederson JB, Wilson CB: Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71:359367, 1989

    • Search Google Scholar
    • Export Citation
  • 3

    Broggi G, Broggi M, Ferroli P, Franzini A: Surgical technique for trigeminal microvascular decompression. Acta Neurochir (Wien) 154:10891095, 2012

    • Search Google Scholar
    • Export Citation
  • 4

    Burchiel KJ: A new classification for facial pain. Neurosurgery 53:11641167, 2003

  • 5

    Burchiel KJ, Clarke H, Haglund M, Loeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:3538, 1988

    • Search Google Scholar
    • Export Citation
  • 6

    Chang EF, Smith JS, Chang SM, Lamborn KR, Prados MD, Butowski N, : Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109:817824, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Cohen J, Cohen P, West S, Aiken L: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, ed 3. Mahwah, NJ: Lawrence Erlbaum Associates, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Jannetta PJ: Neurovascular compression in cranial nerve and systemic disease. Ann Surg 192:518525, 1980

  • 9

    Jie H, Xuanchen Z, Deheng L, Kun G, Fengyang X, Xiang C, : The long-term outcome of nerve combing for trigeminal neuralgia. Acta Neurochir (Wien) 155:17031708, 2013

    • Search Google Scholar
    • Export Citation
  • 10

    Jo KW, Kong DS, Hong KS, Lee JA, Park K: Long-term prognostic factors for microvascular decompression for trigeminal neuralgia. J Clin Neurosci 20:440445, 2013

    • Search Google Scholar
    • Export Citation
  • 11

    Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ: Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg 122:10481057, 2015

    • Search Google Scholar
    • Export Citation
  • 12

    Kulkarni AV, Drake JM, Mallucci CL, Sgouros S, Roth J, Constantini S: Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr 155:254259, 259.e1, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Leal PR, Hermier M, Froment JC, Souza MA, Cristino-Filho G, Sindou 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) 152:817825, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Lee A, McCartney S, Burbidge C, Raslan AM, Burchiel KJ: Trigeminal neuralgia occurs and recurs in the absence of neurovascular compression. J Neurosurg 120:10481054, 2014

    • Search Google Scholar
    • Export Citation
  • 15

    Li ST, Pan Q, Liu N, Shen F, Liu Z, Guan Y: Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 62:400405, 2004

    • Search Google Scholar
    • Export Citation
  • 16

    Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L: Significance of neurovascular contact in classical trigeminal neuralgia. Brain 138:311319, 2015

    • Search Google Scholar
    • Export Citation
  • 17

    Miller JP, Magill ST, Acar F, Burchiel KJ: Predictors of long-term success after microvascular decompression for trigeminal neuralgia. J Neurosurg 110:620626, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    Sindou M, Howeidy T, Acevedo 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) 144:113, 2002

    • Search Google Scholar
    • Export Citation
  • 19

    Sindou M, Leston J, Decullier E, Chapuis 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 107:11441153, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, : Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:527531, 2002

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 629 373 55
Full Text Views 140 64 6
PDF Downloads 188 73 7
EPUB Downloads 0 0 0