Skip to main content

Advertisement

SpringerLink
Log in

Microvascular decompression using autologous muscle graft for trigeminal neuralgia: a case series and meta-analysis

  • Review Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

We aimed to describe a case series of patients diagnosed with trigeminal neuralgia (TN) who were submitted to microvascular decompression (MVD) using autologous muscle graft (AMG) and perform a systematic review and meta-analysis.

Methods

Forty-four adult patients who underwent MVD using AMG between 2012 and 2022 were studied retrospectively. Demographic, clinical, and surgical factors were assessed. We systematically reviewed PubMed, Embase, and Cochrane Library from inception to May 2023. We used random-effects model for all outcomes. Heterogeneity was assessed with I2. We used R software 4.3.1 for all statistical analyses.

Results

Among patients in the case series, the mean age was 52 ± 12.9 years, and the proportion of females was 65.9%. Forty-one patients (93.2%) presented complete pain relief after a mean follow-up of 7.7 years. The pooled analysis of immediate pain relief was 91.3% (95% CI 82–96%; I2=78%). The good pain relief during follow-up was 88.2% (95% CI 78–94%; I2=80%) at follow-up. The recurrence rates at 6, 12, 36 months, and during follow-up were 6.2%, 10.5%, 10.3%, and 11%, respectively.

Conclusion

In this case series and meta-analysis of over 440 patients, our findings suggest that the practice of MVD using AMG may be an efficient option in the short term as surgical treatment for TN. Further trials should compare AMG with other materials and its effectiveness in a long-term follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

Data or information needed to re-produce the findings presented are available from the corresponding author upon reasonable request while also patient confidentiality.

Code availability

The code underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

AICA:

Anterior inferior cerebellar artery

AMG:

Autologous muscle graft

BA:

Basilar artery

BNI:

Barrow Neurological Institute

CI:

Confidence interval

CSF:

Cerebrospinal fluid

FIESTA:

Fast imaging employing steady-state acquisition

MRI:

Magnetic resonance imaging

MVD:

Microvascular decompression

NIH:

National Institute of Health

NVC:

Neurovascular compression

PICA:

Posterior inferior cerebellar artery

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

PROSPERO:

International Prospective Register of Systematic Reviews

REZ:

Root entry zone

SCA:

Superior cerebellar artery

SPV:

Superior petrosal vein

TN:

Trigeminal neuralgia

T:

Trigeminal nerve

TPV:

Transverse pontine vein

References

  1. Alizadeh Y, Hayak H, Khoshnevisan A (2022) Microvascular decompression versus gamma knife surgery in patients with drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. World Neurosurg 167:67–73

    Article  PubMed  Google Scholar 

  2. 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(17):1077–1084

    Article  PubMed  Google Scholar 

  3. Bendtsen L, Zakrzewska JM, Abbott J et al (2019) European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 26(6):831–849

    Article  CAS  PubMed  Google Scholar 

  4. 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(1):172–177

    Article  PubMed  Google Scholar 

  5. Broggi G (2000) Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68(1):59–64

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Capelle H-H, Brandis A, Tschan CA, Krauss JK (2010) Treatment of recurrent trigeminal neuralgia due to Teflon granuloma. J Headache Pain 11(4):339–344

    Article  PubMed  PubMed Central  Google Scholar 

  7. Charalampaki P, Kafadar AM, Grunert P, Ayyad A, Perneczky A (2008) Vascular decompression of trigeminal and facial nerves in the posterior fossa under endoscope-assisted keyhole conditions. Skull Base Off J North Am Skull Base Soc Al 18(2):117–128

    CAS  Google Scholar 

  8. Cho D-Y, Chang CG-S, Wang Y-C, Wang F-H, Shen C-C, Yang D-Y (1994) Repeat operations in failed microvascular decompression for trigeminal neuralgia. Neurosurgery 35(4):665–670

    Article  CAS  PubMed  Google Scholar 

  9. Cohen-Gadol AA (2011) Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm: Naunces of the technique based on experiences with 100 patients and review of the literature. Clin Neurol Neurosurg 113(10):844–853

    Article  PubMed  Google Scholar 

  10. Deep NL, Graffeo CS, Copeland WR, Link MJ, Atkinson JL, Neff BA, Raghunathan A, Carlson ML (2017) Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression: CPA Teflon Granuloma After MVD. Laryngoscope 127(3):715–719

    Article  PubMed  Google Scholar 

  11. Haidar H, Montava M, Collin M, Deveze A, Lavieille JP (2014) Endoscopy-assisted microvascular decompression for trigeminal neuralgia: the prognostic impact of interposing material. J Int Adv Otol 10(2):107–112

    Article  Google Scholar 

  12. Headache Classification Committee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia Int J Headache 38(1):1–211

    Article  Google Scholar 

  13. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022.  http://www.training.cochrane.org/handbook.

  14. Jagannath PM, Venkataramana NK, Bansal A, Ravichandra M (2012) Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: a five-year prospective study. Asian J Neurosurg 7(3):125–130

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jannetta PJ, McLaughlin MR, Casey KF (2005) Technique of microvascular decompression. Technical note. Neurosurg Focus 18(5):E5

    Article  PubMed  Google Scholar 

  16. Karki P, Joshi S, Paudel P, Shah DB, Sharma GR (2021) Microvascular decompression using muscle graft for interposition: a retrospective study. Nepal J Neurosci 18(2):55–60

    Article  Google Scholar 

  17. Leal PRL, Hermier M, Froment JC, Souza MA, Cristino-Filho G, Sindou M (2010) Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 152(5):817–825

    Article  PubMed  Google Scholar 

  18. Leal PRL, Hermier M, Souza MA, Cristino-Filho G, Froment JC, Sindou M (2011) Visualization of vascular compression of the trigeminal nerve with high-resolution 3T MRI: a prospective study comparing preoperative imaging analysis to surgical findings in 40 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Neurosurgery 69(1):15–26

    Article  PubMed  Google Scholar 

  19. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90(1):1–8

    Article  CAS  PubMed  Google Scholar 

  20. Megerian CA, Busaba NY, McKenna MJ, Ojemann RG (1995) Teflon granuloma presenting as an enlarging, gadolinium enhancing, posterior fossa mass with progressive hearing loss following microvascular decompression. Am J Otol 16(6):783–786

    CAS  PubMed  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, Altman DG, for the PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535–b2535

    Article  PubMed  PubMed Central  Google Scholar 

  22. NIH. Quality assessment tool for case series studies. 2014.  https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascularrisk-reduction/tools/case_series. Accessed June, 2023.

  23. Premsagar IC, Moss T, Coakham HB (1997) Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression: report of two cases. J Neurosurg 87(3):454–457

    Article  CAS  PubMed  Google Scholar 

  24. Pressman E, Hasegawa H, Farooq J et al (2021) Teflon versus Ivalon in microvascular decompression for trigeminal neuralgia: a 2-center 10-year comparison. World Neurosurg 146:e822–e828

    Article  PubMed  Google Scholar 

  25. Pressman E, Jha RT, Zavadskiy G, Kumar JI, Van Loveren H, Van Gompel JJ, Agazzi S (2020) TeflonTM or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia. Neurosurg Rev 43(1):79–86

    Article  PubMed  Google Scholar 

  26. Sindou M, Howeidy T, Acevedo G (2002) Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective Study in a Series of 579 Patients. Acta Neurochir (Wien) 144(1):1–13

    Article  CAS  PubMed  Google Scholar 

  27. Sindou M, Leston J, Decullier E, Chapuis F (2007) Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107(6):1144–1153

    Article  PubMed  Google Scholar 

  28. 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(12):1235–1245

    Article  CAS  PubMed  Google Scholar 

  29. Sindou M, Leston JM, Decullier E, Chapuis F (2008) Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique— Kaplan-Meier analysis in a consecutive series of 330 patients. Oper Neurosurg 63(4):341–351

    Article  Google Scholar 

  30. Steinberg JA, Sack J, Wilson B, Weingarten D, Carter B, Khalessi A, Ben-Haim S, Alksne J (2019) Tentorial sling for microvascular decompression in patients with trigeminal neuralgia: a description of operative technique and clinical outcomes. J Neurosurg 130(4):1315–1320

    Article  Google Scholar 

  31. Tatli M, Satici O, Kanpolat Y, Sindou M (2008) Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 150(3):243–255

    Article  CAS  PubMed  Google Scholar 

  32. Tomasello F, Esposito F, Abbritti RV, Angileri FF, Conti A, Cardali SM, La Torre D (2016) Microvascular decompression for trigeminal neuralgia: technical refinement for complication avoidance. World Neurosurg 94:26–31

    Article  PubMed  Google Scholar 

  33. Tomasello F, Germanò A, Lavano A, Romano A, Cafarella D, Gorgoglione N, La Torre D (2020) A novel technical refinement of microvascular decompression: pain relief and complication rate in a consecutive series of patients with trigeminal neuralgia. Oper Neurosurg 19(3):226–233

    Article  Google Scholar 

  34. 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(6):1261–1267 discussion 1267-1268

    CAS  PubMed  Google Scholar 

  35. Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, Chang Y-F (2002) Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96(3):527–531

    Article  PubMed  Google Scholar 

  36. ul Haq N, Ali M, Khan HM, Ishaq M, Khattak MI (2016) Immediate pain relief by microvascular decompression for idiopathic trigeminal neuralgia. J Ayub Med Coll Abbottabad JAMC 28(1):52–55

    PubMed  Google Scholar 

  37. Vitali AM, Sayer FT, Honey CR (2007) Recurrent trigeminal neuralgia secondary to Teflon felt. Acta Neurochir (Wien) 149(7):719–722

    Article  CAS  PubMed  Google Scholar 

  38. Yamaki T, Hashi K, Niwa J, Tanabe S, Nakagawa T, Nakamura T, Uede T, Tsuruno T (1992) Results of reoperation for failed microvascular decompression. Acta Neurochir (Wien) 115(1–2):1–7

    Article  CAS  PubMed  Google Scholar 

  39. Zagzoog N, Attar A, Takroni R, Alotaibi MB, Reddy K (2019) Endoscopic versus open microvascular decompression for trigeminal neuralgia: a systematic review and comparative meta-analysis. J Neurosurg 131(5):1532–1540

    Article  Google Scholar 

  40. Zhong J, Li S-T, Zhu J, Guan H-X, Zhou Q-M, Jiao W, Ying T-T, Yang X-S, Zhan W-C, Hua X-M (2012) A clinical analysis on microvascular decompression surgery in a series of 3000 cases. Clin Neurol Neurosurg 114(7):846–851

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Gabriel Marinheiro dos Santos Bezerra and Paulo Roberto Lacerda Leal contributed equally to this work.

Authors and Affiliations

  1. Departament of Neurosurgery, Federal University of Ceará, 100 Comandante Maurocélio Rocha Pontes Avenue, Sobral, Ceará, 62042-250, Brazil

    Gabriel Marinheiro dos Santos Bezerra, Paulo Roberto Lacerda Leal, Joaquim Francisco Cavalcante-Neto, Keven Ferreira da Ponte & Gerardo Cristino-Filho

  2. Department of Neurosurgery, North Regional Hospital, Sobral, Brazil

    Paulo Roberto Lacerda Leal, Keven Ferreira da Ponte & Gerardo Cristino-Filho

  3. Department of Medicine, Nove de Julho University, São Bernardo do Campo, Brazil

    André Rivera

Authors
  1. Gabriel Marinheiro dos Santos Bezerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paulo Roberto Lacerda Leal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joaquim Francisco Cavalcante-Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. André Rivera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keven Ferreira da Ponte
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerardo Cristino-Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of the work: GMSB and PRLL. Acquisition, analysis, and interpretation of data: GMSB, PRLL, JFC-N, and AR. Drafting and critically review: GMSB, PRLL, JFC-N, AR, KFP, and GC-F. All authors agreed to the publication of this work.

Corresponding author

Correspondence to Paulo Roberto Lacerda Leal.

Ethics declarations

Ethics approval

This study was approved by the ethical standards of the institutional and/or national research committee. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate and for publication

Informed consent was acquired from all patients.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 481 kb)

ESM 2

(XLSX 9 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bezerra, G.M.S., Leal, P.R.L., Cavalcante-Neto, J.F. et al. Microvascular decompression using autologous muscle graft for trigeminal neuralgia: a case series and meta-analysis. Acta Neurochir 165, 3833–3843 (2023). https://doi.org/10.1007/s00701-023-05871-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-023-05871-5

Keywords

Search

Navigation