Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes Review Article First Online: 14 January 2008 Received: 22 May 2007 Accepted: 06 November 2007 DOI:
Cite this article as: Tatli, M., Satici, O., Kanpolat, Y. et al. Acta Neurochir (Wien) (2008) 150: 243. doi:10.1007/s00701-007-1488-3 Summary Background. The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. Method. All studies that had a minimum 5 years or more (≥5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student’s t-test, Chi-square followed by Pearson’s risk analysis tests were used. Kaplan–Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. Findings. Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities ( P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD ( P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. Conclusions. The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient’ satisfaction with the lowest rate of pain recurrence. Keywords: Glycerol rhizotomy; long-term outcome; microvascular decompression; partial sensory rhizotomy; percutaneous balloon microcompression; radiofrequency thermorhizotomy; stereotactic radiosurgery; trigeminal neuralgia.
Correspondence: Dr. Mehmet Tatli, Assistant Professor, Department of Neurosurgery, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey.
References Abdennebi, B, Mahfouf, L, Nedjahi, T 1997 Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia (series of 200 patients) Stereotact Funct Neurosurg 68 190 195 PubMed CrossRef Google Scholar Apfelbaum, RJ 1988 Surgical management of disorders of the lower cranial nerves Schmideck, HH Sweet, WH eds. Operative neurosurgical techniques2 Grune & Stratton New York 1097 1109 Google Scholar Barker, FG, Jannetta, PJ, Bissonette, DJ, Larkins, MV, Jho, HD 1996 The long-term outcome of microvascular decompression for trigeminal neuralgia N Engl J Med 334 1077 1083 PubMed CrossRef Google Scholar Bederson, JB, Wilson, CB 1989 Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia J Neurosurg 71 359 367 PubMed Google Scholar Brisman, R 2007 Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings Stereotact Funct Neurosurg 85 94 98 PubMed CrossRef Google Scholar Broggi, G, Franzini, A, Lasio, G, Giorgi, C, Servello, D 1990 Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients Neurosurgery 26 783 786 PubMed CrossRef Google Scholar Browne, L 1985 Radiofrequency lesioning of the trigeminal ganglion for the treatment of trigeminal neuralgia Ir Med J 78 68 71 PubMed Google Scholar de Siqueira, SR, da Nobrega, JC, de Siqueira, JT, Teixeira, MJ 2006 Frequency of postoperative complications after balloon compression for idiopathic trigeminal neuralgia: prospective study Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102 39 45 CrossRef Google Scholar Flickinger, JC, Pollock, BE, Kondziolka, D, Phuong, LK, Foote, RL, Stafford, SL, Lunsford, LD 2001 Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study Int J Radiat Oncol Biol Phys 51 449 454 PubMed Google Scholar Fountas, KN, Lee, GP, Smith, JR 2006 Outcome of patients undergoing gamma knife stereotactic radiosurgery for medically refractory idiopathic trigeminal neuralgia: medical college of Georgia’s experience Stereotact Funct Neurosurg 84 88 96 PubMed CrossRef Google Scholar Hakanson, S 1981 Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern Neurosurgery 9 638 646 PubMed CrossRef Google Scholar Kanpolat, Y, Savas, A, Bekar, A, Berk, C 2001 Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patients Neurosurgery 48 524 532 PubMed CrossRef Google Scholar Katusic, S, Beard, CM, Bergstralh, E, Kurland, LT 1990 Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984 Ann Neurol 27 89 95 PubMed CrossRef Google Scholar Klun, B 1992 Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patients Neurosurgery 30 49 52 PubMed CrossRef Google Scholar Kolluri, S, Heros, RC 1984 Microvascular decompression for trigeminal neuralgia. A five-year follow-up study Surg Neurol 22 235 240 PubMed CrossRef Google Scholar Kondo, A 2001 Microvascular decompression surgery for trigeminal neuralgia Stereotact Funct Neurosurg 77 187 189 PubMed CrossRef Google Scholar Kondziolka, D, Lacomis, D, Niranjan, A, Mori, Y, Maesawa, S, Fellows, W, Lunsford, LD 2000 Histological effects of trigeminal nerve radiosurgery in a primate model:implications for trigeminal neuralgia radiosurgery Neurosurgery 46 971 976 PubMed CrossRef Google Scholar Langford, P, Holt, ME, Danks, RA 2005 Cavernous sinus fistula following percutaneous balloon compression of the trigeminal ganglion. Case report J Neurosurg 103 176 178 PubMed Google Scholar Latchaw, JP, Jr, Hardy, RW, Jr, Forsythe, SB, Cook, AF 1983 Trigeminal neuralgia treated by radiofrequency coagulation J Neurosurg 59 479 484 PubMed Google Scholar Lee, KH, Chang, JW, Park, YG, Chung, SS 1997 Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia Stereotact Funct Neurosurg 68 196 199 PubMed CrossRef Google Scholar Lichtor, T, Mullan, JF 1990 A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion J Neurosurg 72 49 54 PubMed Google Scholar Lopez, BC, Peter, JH, Zakrzewska, JM 2004 Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgia Neurosurgery 54 973 983 PubMed CrossRef Google Scholar Lunsford, LD 1987 Glycerol rhizotomy for trigeminal neuralgia J Neurosurg 66 151 152 PubMed Google Scholar Mendoza, N, Illingworth, RD 1995 Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up study Br J Neurosurg 9 13 19 PubMed CrossRef Google Scholar Menzel, J, Piotrowski, W, Penzholz, H 1975 Long-term results of Gasserian ganglion electrocoagulation J Neurosurg 42 140 143 PubMed Google Scholar Nugent, GR 1997 Radiofrequency treatment of trigeminal neuralgia using a cordotomy-type electrode: a method Neurosurg Clin N Am 8 41 52 PubMed Google Scholar Olson, S, Atkinson, L, Weidmann, M 2005 Microvascular decompression for trigeminal neuralgia: recurrences and complications J Clin Neurosci 12 787 789 PubMed CrossRef Google Scholar Oturai, AB, Jensen, K, Eriksen, J, Madsen, F 1996 Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and radiofrequency coagulation Clin J Pain 12 311 315 PubMed CrossRef Google Scholar Pollock, BE, Phuong, LK, Gorman, DA, Foote, RL, Stafford, SL 2002 Stereotactic radiosurgery for idiopathic trigeminal neuralgia J Neurosurg 97 347 353 PubMed Google Scholar Pollock, BE 2006 Radiosurgery for trigeminal neuralgia: is sensory disturbance required for pain relief? J Neurosurg 105 103 106 PubMed Google Scholar Regis, J, Metellus, P, Hayashi, M, Roussel, P, Donnet, A, Bille-Turc, F 2006 Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia J Neurosurg 104 913 924 PubMed CrossRef Google Scholar 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 1013 1019 PubMed Google Scholar Sindou, M 1999 Neurophysiological navigation in the trigeminal nerve: use of masticatory responses and facial motor responses evoked by electrical stimulation of the trigeminal rootlets for RF-Thermorhizotomy guidance Stereotact Funct Neurosurg 73 117 121 PubMed CrossRef Google Scholar Sindou, M, Leston, J, Howeidy, T, Decullier, E, Chapuis, F 2006 Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients Acta Neurochir (Wien) 148 1235 1245 CrossRef Google Scholar Skirving, DJ, Dan, NG 2001 A 20-year review of percutaneous balloon compression of the trigeminal ganglion J Neurosurg 94 913 917 PubMed Google Scholar Spaziante, R, Cappabianca, P, Peca, C, de Divitiis, E 1988 Subarachnoid haemorrhage and “normal pressure hydrocephalus”: Fatal complication of percutaneous microcompression of the gasserian ganglion. Case report Neurosurgery 22 148 151 PubMed CrossRef Google Scholar Steiger, HJ 1991 Prognostic factors in the treatment of trigeminal neuralgia: analysis of a differential therapeutic approach Acta Neurochir (Wien) 113 11 17 CrossRef Google Scholar Sun, T, Saito, S, Nakai, O, Ando, T 1994 Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrence Acta Neurochir (Wien) 126 144 148 CrossRef Google Scholar Sweet, WH, Wepsic, JG 1974 Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1. Trigeminal neuralgia J Neurosurg 40 143 156 PubMed CrossRef Google Scholar Taha, JM, Tew, JM, Jr, Buncher, CR 1995 A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy J Neurosurg 83 989 993 PubMed Google Scholar Taha, JM, Tew, JM, Jr 1996 Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy Neurosurgery 38 865 871 PubMed CrossRef Google Scholar Tatli, M, Keklikci, U, Aluclu, U, Akdeniz, S 2006 Anesthesia dolorosa caused by penetrating cranial injury Eur Neurol 56 162 165 PubMed CrossRef Google Scholar
The National Institute for Clinical Excelence (2004) Stereotactic radiosurgery for trigeminal neuralgia using the gamma knife.
http://guidance.nice.org.uk/IPG85 Tronnier, VM, Rasche, D, Hamer, J, Kienle, AL, Kunze, S 2001 Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression Neurosurgery 48 1261 1267 PubMed CrossRef Google Scholar Tyler-Kabara, EC, Kassam, AB, Horowitz, MH, Urgo, L, Hadjipanayis, C, Levy, EI, Chang, YF 2002 Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression J Neurosurg 96 527 531 PubMed Google Scholar Urgosik, D, Liscak, R, Novotny, J, Jr, Vymazal, J, Vladyka, V 2005 Treatment of essential trigeminal neuralgia with gamma knife surgery J Neurosurg 102 29 33 PubMed Google Scholar Van Loveren, H, Tew, JM, Jr, Keller, JT, Nurre, MA 1982 A 10-year experience in the treatment of trigeminal neuralgia. Comparison of percutaneous stereotaxic rhizotomy and posterior fossa exploration J Neurosurg 57 757 764 PubMed CrossRef Google Scholar Walchenbach, R, Voormolen, JH, Hermans, J 1994 Microvascular decompression for trigeminal neuralgia: a critical reappraisal Clin Neurol Neurosurg 96 290 295 PubMed CrossRef Google Scholar Yoon, KB, Wiles, JR, Miles, JB, Nurmikko, TJ 1999 Long-term outcome of percutaneous thermocoagulation for trigeminal neuralgia Anaesthesia 54 803 808 PubMed CrossRef Google Scholar Zakrzewska, JM, Thomas, DG 1993 Patient’s assessment of outcome after three surgical procedures for the management of trigeminal neuralgia Acta Neurochir (Wien) 122 225 230 CrossRef Google Scholar Zakrzewska, JM, Lopez, BC, Kim, SE, Coakham, HB 2005 Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia Neurosurgery 56 1304 1311 PubMed CrossRef Google Scholar