Acta Neurochirurgica

, Volume 150, Issue 3, pp 243–255 | Cite as

Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes

Review Article

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. 

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References

  1. Abdennebi, B, Mahfouf, L, Nedjahi, T 1997Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia (series of 200 patients)Stereotact Funct Neurosurg68190195PubMedCrossRefGoogle Scholar
  2. Apfelbaum, RJ 1988

    Surgical management of disorders of the lower cranial nerves

    Schmideck, HHSweet, WH eds. Operative neurosurgical techniques2Grune & StrattonNew York10971109
    Google Scholar
  3. Barker, FG, Jannetta, PJ, Bissonette, DJ, Larkins, MV, Jho, HD 1996The long-term outcome of microvascular decompression for trigeminal neuralgiaN Engl J Med33410771083PubMedCrossRefGoogle Scholar
  4. Bederson, JB, Wilson, CB 1989Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgiaJ Neurosurg71359367PubMedGoogle Scholar
  5. Brisman, R 2007Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findingsStereotact Funct Neurosurg859498PubMedCrossRefGoogle Scholar
  6. Broggi, G, Franzini, A, Lasio, G, Giorgi, C, Servello, D 1990Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patientsNeurosurgery26783786PubMedCrossRefGoogle Scholar
  7. Browne, L 1985Radiofrequency lesioning of the trigeminal ganglion for the treatment of trigeminal neuralgiaIr Med J786871PubMedGoogle Scholar
  8. de Siqueira, SR, da Nobrega, JC, de Siqueira, JT, Teixeira, MJ 2006Frequency of postoperative complications after balloon compression for idiopathic trigeminal neuralgia: prospective studyOral Surg Oral Med Oral Pathol Oral Radiol Endod1023945CrossRefGoogle Scholar
  9. Flickinger, JC, Pollock, BE, Kondziolka, D, Phuong, LK, Foote, RL, Stafford, SL, Lunsford, LD 2001Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized studyInt J Radiat Oncol Biol Phys51449454PubMedGoogle Scholar
  10. Fountas, KN, Lee, GP, Smith, JR 2006Outcome of patients undergoing gamma knife stereotactic radiosurgery for medically refractory idiopathic trigeminal neuralgia: medical college of Georgia’s experienceStereotact Funct Neurosurg848896PubMedCrossRefGoogle Scholar
  11. Hakanson, S 1981Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cisternNeurosurgery9638646PubMedCrossRefGoogle Scholar
  12. Kanpolat, Y, Savas, A, Bekar, A, Berk, C 2001Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1600 patientsNeurosurgery48524532PubMedCrossRefGoogle Scholar
  13. Katusic, S, Beard, CM, Bergstralh, E, Kurland, LT 1990Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984Ann Neurol278995PubMedCrossRefGoogle Scholar
  14. Klun, B 1992Microvascular decompression and partial sensory rhizotomy in the treatment of trigeminal neuralgia: personal experience with 220 patientsNeurosurgery304952PubMedCrossRefGoogle Scholar
  15. Kolluri, S, Heros, RC 1984Microvascular decompression for trigeminal neuralgia. A five-year follow-up studySurg Neurol22235240PubMedCrossRefGoogle Scholar
  16. Kondo, A 2001Microvascular decompression surgery for trigeminal neuralgiaStereotact Funct Neurosurg77187189PubMedCrossRefGoogle Scholar
  17. Kondziolka, D, Lacomis, D, Niranjan, A, Mori, Y, Maesawa, S, Fellows, W, Lunsford, LD 2000Histological effects of trigeminal nerve radiosurgery in a primate model:implications for trigeminal neuralgia radiosurgeryNeurosurgery46971976PubMedCrossRefGoogle Scholar
  18. Langford, P, Holt, ME, Danks, RA 2005Cavernous sinus fistula following percutaneous balloon compression of the trigeminal ganglion. Case reportJ Neurosurg103176178PubMedGoogle Scholar
  19. Latchaw, JP,Jr, Hardy, RW,Jr, Forsythe, SB, Cook, AF 1983Trigeminal neuralgia treated by radiofrequency coagulationJ Neurosurg59479484PubMedGoogle Scholar
  20. Lee, KH, Chang, JW, Park, YG, Chung, SS 1997Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgiaStereotact Funct Neurosurg68196199PubMedCrossRefGoogle Scholar
  21. Lichtor, T, Mullan, JF 1990A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglionJ Neurosurg724954PubMedGoogle Scholar
  22. Lopez, BC, Peter, JH, Zakrzewska, JM 2004Systematic review of ablative neurosurgical techniques for the treatment of trigeminal neuralgiaNeurosurgery54973983PubMedCrossRefGoogle Scholar
  23. Lunsford, LD 1987Glycerol rhizotomy for trigeminal neuralgiaJ Neurosurg66151152PubMedGoogle Scholar
  24. Mendoza, N, Illingworth, RD 1995Trigeminal neuralgia treated by microvascular decompression: a long-term follow-up studyBr J Neurosurg91319PubMedCrossRefGoogle Scholar
  25. Menzel, J, Piotrowski, W, Penzholz, H 1975Long-term results of Gasserian ganglion electrocoagulationJ Neurosurg42140143PubMedGoogle Scholar
  26. Nugent, GR 1997Radiofrequency treatment of trigeminal neuralgia using a cordotomy-type electrode: a methodNeurosurg Clin N Am84152PubMedGoogle Scholar
  27. Olson, S, Atkinson, L, Weidmann, M 2005Microvascular decompression for trigeminal neuralgia: recurrences and complicationsJ Clin Neurosci12787789PubMedCrossRefGoogle Scholar
  28. Oturai, AB, Jensen, K, Eriksen, J, Madsen, F 1996Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and radiofrequency coagulationClin J Pain12311315PubMedCrossRefGoogle Scholar
  29. Pollock, BE, Phuong, LK, Gorman, DA, Foote, RL, Stafford, SL 2002Stereotactic radiosurgery for idiopathic trigeminal neuralgiaJ Neurosurg97347353PubMedGoogle Scholar
  30. Pollock, BE 2006Radiosurgery for trigeminal neuralgia: is sensory disturbance required for pain relief?J Neurosurg105103106PubMedGoogle Scholar
  31. Regis, J, Metellus, P, Hayashi, M, Roussel, P, Donnet, A, Bille-Turc, F 2006Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgiaJ Neurosurg104913924PubMedCrossRefGoogle Scholar
  32. Rogers, CL, Shetter, AG, Fiedler, JA, Smith, KA, Han, PP, Speiser, BL 2000Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the barrow neurological instituteInt J Radiat Oncol Biol Phys4710131019PubMedGoogle Scholar
  33. Sindou, M 1999Neurophysiological navigation in the trigeminal nerve: use of masticatory responses and facial motor responses evoked by electrical stimulation of the trigeminal rootlets for RF-Thermorhizotomy guidanceStereotact Funct Neurosurg73117121PubMedCrossRefGoogle Scholar
  34. Sindou, M, Leston, J, Howeidy, T, Decullier, E, Chapuis, F 2006Micro-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 patientsActa Neurochir (Wien)14812351245CrossRefGoogle Scholar
  35. Skirving, DJ, Dan, NG 2001A 20-year review of percutaneous balloon compression of the trigeminal ganglionJ Neurosurg94913917PubMedGoogle Scholar
  36. Spaziante, R, Cappabianca, P, Peca, C, de Divitiis, E 1988Subarachnoid haemorrhage and “normal pressure hydrocephalus”: Fatal complication of percutaneous microcompression of the gasserian ganglion. Case reportNeurosurgery22148151PubMedCrossRefGoogle Scholar
  37. Steiger, HJ 1991Prognostic factors in the treatment of trigeminal neuralgia: analysis of a differential therapeutic approachActa Neurochir (Wien)1131117CrossRefGoogle Scholar
  38. Sun, T, Saito, S, Nakai, O, Ando, T 1994Long-term results of microvascular decompression for trigeminal neuralgia with reference to probability of recurrenceActa Neurochir (Wien)126144148CrossRefGoogle Scholar
  39. Sweet, WH, Wepsic, JG 1974Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1. Trigeminal neuralgiaJ Neurosurg40143156PubMedCrossRefGoogle Scholar
  40. Taha, JM, Tew, JM,Jr, Buncher, CR 1995A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomyJ Neurosurg83989993PubMedGoogle Scholar
  41. Taha, JM, Tew, JM,Jr 1996Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomyNeurosurgery38865871PubMedCrossRefGoogle Scholar
  42. Tatli, M, Keklikci, U, Aluclu, U, Akdeniz, S 2006Anesthesia dolorosa caused by penetrating cranial injuryEur Neurol56162165PubMedCrossRefGoogle Scholar
  43. The National Institute for Clinical Excelence (2004) Stereotactic radiosurgery for trigeminal neuralgia using the gamma knife. http://guidance.nice.org.uk/IPG85
  44. Tronnier, VM, Rasche, D, Hamer, J, Kienle, AL, Kunze, S 2001Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompressionNeurosurgery4812611267PubMedCrossRefGoogle Scholar
  45. Tyler-Kabara, EC, Kassam, AB, Horowitz, MH, Urgo, L, Hadjipanayis, C, Levy, EI, Chang, YF 2002Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompressionJ Neurosurg96527531PubMedGoogle Scholar
  46. Urgosik, D, Liscak, R, Novotny, J,Jr, Vymazal, J, Vladyka, V 2005Treatment of essential trigeminal neuralgia with gamma knife surgeryJ Neurosurg1022933PubMedGoogle Scholar
  47. Van Loveren, H, Tew, JM,Jr, Keller, JT, Nurre, MA 1982A 10-year experience in the treatment of trigeminal neuralgia. Comparison of percutaneous stereotaxic rhizotomy and posterior fossa explorationJ Neurosurg57757764PubMedCrossRefGoogle Scholar
  48. Walchenbach, R, Voormolen, JH, Hermans, J 1994Microvascular decompression for trigeminal neuralgia: a critical reappraisalClin Neurol Neurosurg96290295PubMedCrossRefGoogle Scholar
  49. Yoon, KB, Wiles, JR, Miles, JB, Nurmikko, TJ 1999Long-term outcome of percutaneous thermocoagulation for trigeminal neuralgiaAnaesthesia54803808PubMedCrossRefGoogle Scholar
  50. Zakrzewska, JM, Thomas, DG 1993Patient’s assessment of outcome after three surgical procedures for the management of trigeminal neuralgiaActa Neurochir (Wien)122225230CrossRefGoogle Scholar
  51. Zakrzewska, JM, Lopez, BC, Kim, SE, Coakham, HB 2005Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgiaNeurosurgery5613041311PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of NeurosurgeryHospital Neurologique ‘Pierre Wertheimer’ Hospital, University of LyonLyonFrance
  2. 2.Department of Biostatistics, Faculty of MedicineUniversity of DicleDiyarbakirTurkey
  3. 3.Department of Neurosurgery, Faculty of MedicineUniversity of AnkaraAnkaraTurkey

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