Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

Restricted access

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution.

Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors.

Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

Article Information

Address reprint requests to: A. B. Kassam, M.D., Center for Cranial Nerve Disorders, University of Pittsburgh Medical Center, Suite B–400, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213–2582. email: akassam@neuronet.pitt.edu.

© AANS, except where prohibited by US copyright law.

Headings

References

1.

Barker FG IIJannetta PJBissonette DJet al: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:107710831996Barker FG II Jannetta PJ Bissonette DJ et al: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083 1996

2.

Brown JACoursaget CPreul MCet al: Mercury water and cauterizing stones: Nicolas Andre and tic douloureux. J Neurosurg 90:9779811999Brown JA Coursaget C Preul MC et al: Mercury water and cauterizing stones: Nicolas Andre and tic douloureux. J Neurosurg 90:977–981 1999

3.

Burchiel KJSlavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 46:1521552000Burchiel KJ Slavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 46:152–155 2000

4.

Fothergill J: Of a painful affection of the face in Society of Physicians in London: Medical Observations and Inquires. London: T Cadell1773 Vol 5 pp 129142Fothergill J: Of a painful affection of the face in Society of Physicians in London: Medical Observations and Inquires. London: T Cadell 1773 Vol 5 pp 129–142

5.

Hamlyn PJKing TT: Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:9489541992Hamlyn PJ King TT: Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 76:948–954 1992

6.

Jannetta PJRand RW: Transtentorial retrogasserian rhizotomy in trigeminal neuralgia by microneurosurgical technique. Bull LA Neurol Soc 31:93991966Jannetta PJ Rand RW: Transtentorial retrogasserian rhizotomy in trigeminal neuralgia by microneurosurgical technique. Bull LA Neurol Soc 31:93–99 1966

7.

Klun B: Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 30:49521992Klun B: Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients. Neurosurgery 30:49–52 1992

8.

Pollack IFJannetta PJBissonette DJ: Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. J Neurosurg 68:5595651988Pollack IF Jannetta PJ Bissonette DJ: Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. J Neurosurg 68:559–565 1988

9.

Schmidt JE: Medical Discoveries. Springfield, IL: Charles C Thomas1959Schmidt JE: Medical Discoveries. Springfield IL: Charles C Thomas 1959

10.

Stookey BRansohoff J: Trigeminal Neuralgia: Its History and Treatment. Springfield, IL: Charles C Thomas1959Stookey B Ransohoff J: Trigeminal Neuralgia: Its History and Treatment. Springfield IL: Charles C Thomas 1959

11.

Sun TSaito SNakai Oet al: Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence. Acta Neurochir 126:1441481994Sun T Saito S Nakai O et al: Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence. Acta Neurochir 126:144–148 1994

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 28 28 13
Full Text Views 149 149 13
PDF Downloads 34 34 6
EPUB Downloads 0 0 0

PubMed

Google Scholar