Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia
- 19 Downloads
Trigeminal neuralgia (TN) is characterized by jolts of pain along the distribution of the trigeminal nerve. If patients fail conservative management, microvascular decompression (MVD) is the next step in treatment. MVD is largely done by placing implant pads between the nerve and compressing vessels. We conducted a literature review to assess effectiveness and safety of Teflon™ and Ivalon® sponges for treatment of TN with MVD.
In January 2019, PubMed was searched for manuscripts published in English using permutations of “Microvascular decompression”, “Teflon”, “Ivalon”, “Granuloma”, “Polytetrafluoroethylene”, “Trigeminal Neuralgia”, and “Exploration”. Success and relapse rates, causes of relapse, and complication rates were analyzed. We analyzed for relationships with ANCOVA at an alpha threshold of .05.
Thirty-six studies representing 4273 patients fit inclusion criteria. Twenty-five dealt with initial MVD, 12 with re-do MVD. Initial MVD initial success rates were 85% in patients receiving Teflon™ (57–100%*) and 91% in patients receiving Ivalon® (79–100%*). Recurrence rates were 12% in Teflon™ patients (0*–30%) and 9.1% in Ivalon® patients (0*–19%). In patients with relapses, implants were the cause in 49% of Teflon™ patients (0*–100%*) and 50% of Ivalon® patients (0*–100%*). Complication rates for patients receiving Teflon™ were 12% (0*–34%) and 19% for patients receiving Ivalon® (0*–40%).
Teflon™ and Ivalon® are two materials used in MVD for TN. It is an effective treatment with long-term symptom relief and recurrence rates of 1–5% each year. Ivalon® has been used less than Teflon™ though is associated with similar success rates and similar complication rates.
KeywordsIvalon Microvascular decompression Teflon Trigeminal neuralgia
Our scoping review received no financial support for the research, authorship, and/or publication of this article. In addition, of the sources of evidence included in this article, the ones that disclosed a source of funding and the funding received are as follows: Feng et al. (2015) were supported by a grant from the National Science Foundation of China, a grant from the Health Commission of Shanghai, and 2 grants from the Science and Technology Commission of Shanghai. Wu et al. were supported by a grant from the Science and Technology Project of Anhui Province, China. Feng et al. (2018) were supported by a grant from Shanghai Jiao Tong University cross fund for medical engineering.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
As this was a literature review and no patient records were accessed or under study, ethical approval from an overseeing board was not sought.
As this was a literature review and no patient records were accessed or under study, no informed consent was sought.
- 6.Bond AE, Zada G, Gonzalez AA, Hansen C, Giannotta SL (2010) Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia. World Neurosurg 74:172–177. https://doi.org/10.1016/j.wneu.2010.05.001 CrossRefPubMedGoogle Scholar
- 13.El-Garem HF, Badr-El-Dine M, Talaat AM, Magnan J (2002) Endoscopy as a tool in minimally invasive trigeminal neuralgia surgery. Otology & neurotology : official publication of the American Otological Society. American Neurotology Society [and] European Academy of Otology and Neurotology 23:132–135CrossRefGoogle Scholar
- 14.El-Ghandour NM (2010) Microvascular decompression in the treatment of trigeminal neuralgia caused by vertebrobasilar ectasia. Neurosurgery 67:330–337. https://doi.org/10.1227/01.Neu.0000371978.86528.60 CrossRefPubMedGoogle Scholar
- 22.Kabatas S, Karasu A, Civelek E, Sabanci AP, Hepgul KT, Teng YD (2009) Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature. Neurosurg Rev 32:87–93; discussion 93-84. https://doi.org/10.1007/s10143-008-0171-3 CrossRefPubMedGoogle Scholar
- 23.Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT (1991) Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology 10:276–281. https://doi.org/10.1159/000110284 CrossRefPubMedGoogle Scholar
- 31.Sandell T, Eide PK (2008) Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery 63:93–99; discussion 99-100. https://doi.org/10.1227/01.Neu.0000335075.16858.Ef CrossRefPubMedGoogle Scholar
- 32.Sekula RF Jr, Frederickson AM, Jannetta PJ, Quigley MR, Aziz KM, Arnone GD (2011) Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis. J Neurosurg 114:172–179. https://doi.org/10.3171/2010.6.Jns10142 CrossRefPubMedGoogle Scholar
- 33.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 148:1235–1245; discussion 1245. https://doi.org/10.1007/s00701-006-0809-2 CrossRefPubMedGoogle Scholar
- 36.Wu M, Fu X, Ji Y, Ding W, Deng D, Wang Y, Jiang X, Niu C (2018) Microvascular Decompression for Classical Trigeminal Neuralgia Caused by Venous Compression: Novel Anatomic Classifications and Surgical Strategy. World Neurosurg 113:e707–e713. https://doi.org/10.1016/j.wneu.2018.02.130 CrossRefPubMedGoogle Scholar