Abstract
Background
The purpose of this study was to evaluate and analyze overall postoperative results from microvascular decompression (MVD) by combining the cure rate of symptoms with the complication rate. A new scoring system for obtaining objective surgical results from MVD for trigeminal neuralgia (TN) and hemifacial spasm (HFS) is proposed to document treatment results using consistent criteria in a standardized manner.
Method
Surgical results combining complications , if any, were obtained from a questionnaire sent to patients who had undergone surgery for TN or HFS in recent years and had been followed-up for more than 1 year after surgery (TN patients, n = 54; HFS patients, n = 81) When surgical outcome is complete resolution of symptoms, the efficacy of surgery (E) is designated E-0, but when moderate symptoms are still persist postoperatively, the score is designated E-2. When no complications are seen after surgery, the complication score (C) is C-0, while the score is C-2 if troublesome complications remain. In addition, total evaluation of the results (T) is judged by combining the E and C scores. For example, when E is 0, and C is C-2, the total evaluation is scored as T-2, which is diagnosed as fair.
Findings
The response rate of the questionnaire was 80.7% (109/135). Overall surgical data were evaluated and analyzed using our new scoring system. Analysis of the collected data revealed an outcome of T-0 was 70% (35/50 patients) and T-1 was 24% (12/50) and T-2 was 6% (3/50) in TN, whereas in HFS, T-0 was 61% (36/59) and T-1 was 27.1% (16/59) and T-2 was 6.8% (4/59) and T-3 was 5.1% (3/59).
Conclusion
The total results of MVD should be evaluated and analyzed by combining the cure rate of symptoms together with the complication rate. This new scoring system could allow much more objective analysis of the results of following MVD. Adopting this scoring system to objectively judge treatment results for TN and HFS, individual surgeons can compare their own overall surgical results with those of other institutes. Comparative results of MVD can also be provided to patients considering therapy to allow informed decision-making on the basis of good quality evidence.
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References
Barker FG II, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1955) Microvascular decompression for hemifacial spasm. J Neurosurg 82:201–210
Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1966) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083
Chen HI, Lee JY (2010) The measurement of pain in patients with trigeminal neuralgia. Clin Neurosurg 57:129–131
Henson CF, Goldman HW, Rosenwasser RH, Downes MB, Bednarz G, Pequignot EC, Werner-Wasik M, Curran WJ, Andrews DW (2005) Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia; an analysis of patients treated at one institution. Int J Radiat Oncol Biol Phys 63(1):82–90
Jannetta PJ (1977) Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia: definitive microsurgical treatment and results in 117 patients. Neurochirurgie 20:145–154
Kalkanis SN, Eskander EN, Carter BS, Barker FG II (2003) Microvascular decompression surgery in the United States, 1996 to 2000: Mortality rates, morbidity rates, and the effects of hospital and surgeon volumes. Neurosurgery 52(6):1251–1262
Kondo A (1997) Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery 40(1):46–52
Little AS, Shetter AG, Shetter ME, Bay C, Rogers CL (2008) Long–term pain response and quality of life in patients with typical trigeminal neuralgia treated with Gamma knife stereotactic radiosurgery. Neurosurgery 63(5):915–924
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnik DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8
Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL (2000) Gamma knife radiosurgery for trigeminal neuralgia; the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 47(4):1013–1019
Taha JM, Tew JM Jr (1996) Comparison of surgical treatment for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy. Neurosurgery 38(5):865–871
Yamamoto Y, Kondo A, Hanakita J, Nishihara T (1987) Measurement and clinical significance of the posterior fossa volume of patients with hemifacial spasm. No Shinkei Geka 15:243–248
Acknowledgments
We wish thank to Dr. Masatsune Ishikawa for his excellent advice and assistance.
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This method for standardizing the analysis of the overall results of microvascular decompression was presented and discussed at the 13th Meeting of the Japan Society for Microvascular Decompression Surgery on 20 January, 2011, in Hiroshima
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Kondo, A., Date, I., Endo, S. et al. A proposal for standardized analysis of the results of microvascular decompression for trigeminal neuralgia and hemifacial spasm. Acta Neurochir 154, 773–778 (2012). https://doi.org/10.1007/s00701-012-1277-5
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DOI: https://doi.org/10.1007/s00701-012-1277-5