Clinical Article

Acta Neurochirurgica

, Volume 154, Issue 5, pp 773-778

A proposal for standardized analysis of the results of microvascular decompression for trigeminal neuralgia and hemifacial spasm

  • Akinori KondoAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama Hospital Email author 
  • , Isao DateAffiliated withDepartment of Neurosurgery, Okayama University Hospital
  • , Shunro EndoAffiliated withDepartment of Neurosurgery, Toyama University Hospital
  • , Kiyotaka FujiiAffiliated withDepartment of Neurosurgery, Kitasato University Hospital
  • , Yukihiko FujiiAffiliated withDepartment of Neurosurgery, Niigata University Brain Research Institute
  • , Takamitsu FujimakiAffiliated withDepartment of Neurosurgery, Saitama Medical University Hospital
  • , Mitsuhiro HasegawaAffiliated withDepartment of Neurosurgery, Fujita Health University Hospital
  • , Touru HatayamaAffiliated withDepartment of Neurosurgery, Aomori Municipal Hospital
  • , Kazuhiro HongoAffiliated withDepartment of Neurosurgery, Shinshuu University Hospital
    • , Touru InoueAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Fukuoka University Hospital
    • , Masatsune IshikawaAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Rakuwakai Otowa Hospital
    • , Masanori ItoAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Juntendo University Urayasu Hospital
    • , Takamasa KayamaAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Yamagata University Hospital
    • , Eiji KohmuraAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Kobe University Hospital
    • , Toshio MatsushimaAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Saga University Hospital
    • , Shigeru MunemotoAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Ishikawa Prefectural Central Hospital
    • , Shinji NagahiroAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Brain, Tokushima University Hospital
    • , Kikuro OhnoAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery, Tokyo Medical Dental University Hospital
    • , Tomomi OkamuraAffiliated withDepartment of Neurosurgery, Brain, Spine and Neurology Center, Shiroyama HospitalDepartment of Neurosurgery Brain, Ube Industries Central Hospital
    • , Hiroshi RyuAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Aoyama General Hospital
    • , Taku ShigenoAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Kanto Rosai Hospital
    • , Reizo ShiraneAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Miyagi Chidren’s Hospital
    • , Yutaka TagusagawaAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Mitsui Memorial Hospital
    • , Hideki TanabeAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Tanabe Neurosurgical Hospital
    • , Kazuo YamadaAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Nagoya City Universiry Hospital
    • , Iwao YamakamiAffiliated withDepartment of Neurosurgery, Okayama University HospitalDepartment of Neurosurgery, Chiba Central Medical Center

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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.

Keywords

Microvascular decompression Trigeminal neuralgia Hemifacial spasm Surgical results New scoring system