Skip to main content
SpringerLink
Log in

When the nerve keeps firing: an institutional experience and systematic review on delayed response after microvascular decompression for trigeminal neuralgia

  • Review Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Background

This study aimed to investigate the occurrence of delayed response following microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) and identify potential contributing factors. Additionally, we present two cases with delayed relief observed at our institution.

Method

Two TN patients with delayed response and clear intra-operative arterial findings are presented in this study. Furthermore, we conducted a systematic review by searching electronic bibliographic databases, including MEDLINE (PubMed), Web of Science, Scopus, and Embase, from inception to 2022.

Results

We identified a total of 28 full-text articles involving 322 TN patients who experienced delayed pain relief. Out of these, only 11 studies provided sufficient evidence and were included in the final analysis. Among the patients, 73.46% were female. The mean incidence rate of delayed response after MVD treatment for TN was 10.5%, with a range of 0.95 to 57.14% across different studies. The mean age of these patients was 59.86 years. The reported time to pain relief in the existing reports was at least 4 days post-surgery. In 72.88% of the reported cases, right-side dominance was observed. The majority of delayed cases experienced pain relief within 3 months, with a median time of 1 month.

Conclusions

A thorough examination of the probability of delayed pain relief after MVD for TN and understanding the characteristics of this phenomenon can offer surgeons valuable post-operative guidance and aid in decision-making regarding potential immediate reoperation.

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

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

References

  1. Arnold M (2018) Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia 38(1):1–211

    Article  Google Scholar 

  2. Cheshire WP (2003) Trigeminal neuralgia feigns the terrorist. Cephalalgia 23(3):230–230

    Article  CAS  PubMed  Google Scholar 

  3. Tölle T, Dukes E, Sadosky A (2006) Patient burden of trigeminal neuralgia: results from a cross‐sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 6(3):153–160

    Article  PubMed  Google Scholar 

  4. Jones MR et al (2019) A comprehensive review of trigeminal neuralgia. Curr Pain Headache Rep 23(10):1–7

    Article  Google Scholar 

  5. Montano N et al (2015) Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag 11:289

    Article  PubMed  PubMed Central  Google Scholar 

  6. Katusic S et al (1990) Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 27(1):89–95

    Article  CAS  Google Scholar 

  7. Feller L et al (2017) Postherpetic neuralgia and trigeminal neuralgia. Pain Res Treat:2017

  8. Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124(12):2347–2360

    Article  CAS  PubMed  Google Scholar 

  9. Obermann M (2019) Recent advances in understanding/managing trigeminal neuralgia. F1000Research:8

  10. Wang DD et al (2013) Trends in surgical treatment for trigeminal neuralgia in the United States of America from 1988 to 2008. J Clin Neurosci 20(11):1538–1545

    Article  PubMed  Google Scholar 

  11. Zhong J et al (2014) Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases. Neurol Res 36(10):882–893

    Article  PubMed  Google Scholar 

  12. Panczykowski DM et al (2020) Development and Evaluation of a Preoperative Trigeminal Neuralgia Scoring System to Predict Long-Term Outcome Following Microvascular Decompression. Neurosurgery 87(1):71–79

    Article  PubMed  Google Scholar 

  13. Hardaway FA et al (2019) A novel scoring system as a preoperative predictor for pain-free survival after microsurgery for trigeminal neuralgia. J neurosurg 132(1):217–224

    Article  Google Scholar 

  14. Page MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. System Rev 10(1):1–11

    Google Scholar 

  15. Barker FG 2nd et al (1996) Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84(5):818–825

    Article  PubMed  Google Scholar 

  16. Chen JF, Lee ST (2003) Comparison of percutaneous trigeminal ganglion compression and microvascular decompression for the management of trigeminal neuralgia. Clin Neurol Neurosurg 105(3):203–208

    Article  PubMed  Google Scholar 

  17. Li ST et al (2004) Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 62(5):400–404 discussion 404-5

    Article  PubMed  Google Scholar 

  18. Matsushima T, Huynh-Le P, Miyazono M (2004) Trigeminal neuralgia caused by venous compression. Neurosurgery 55(2):334–337 discussion 338-9

    Article  PubMed  Google Scholar 

  19. Li ST et al (2005) Studies on the operative outcomes and mechanisms of microvascular decompression in treating typical and atypical trigeminal neuralgia. Clin J Pain 21(4):311–316

    Article  PubMed  Google Scholar 

  20. Sindou M et al (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 discussion 1245

    Article  CAS  PubMed  Google Scholar 

  21. Linskey ME, Ratanatharathorn V, Peñagaricano J (2008) A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia. J Neurosurg 109(Suppl):160–172

    Article  PubMed  Google Scholar 

  22. Salama H et al (2009) Outcome of medical and surgical management in intractable idiopathic trigeminal neuralgia. Ann Indian Acad Neurol 12(3):173–178

    Article  PubMed  PubMed Central  Google Scholar 

  23. Degn J, Brennum J (2010) Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia. Acta Neurochir 152(12):2125–2132

    Article  PubMed  Google Scholar 

  24. Ferroli P et al (2010) Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice? Neurol Sci 31(1):23–28

    Article  PubMed  Google Scholar 

  25. Hong W et al (2011) Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir (Wien) 153(5):1037–1042

    Article  PubMed  Google Scholar 

  26. Zhong J et al (2011) Microvascular decompressions in patients with coexistent hemifacial spasm and trigeminal neuralgia. Neurosurgery 68(4):916–920 discussion 920

    Article  PubMed  Google Scholar 

  27. Tucer B et al (2012) Microvascular decompression for primary trigeminal neuralgia: Short-term follow-up results and prognostic factors. J Korean Neurosurg Soc 52(1):42–47

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhang L et al (2012) Surgical treatment of primary trigeminal neuralgia: comparison of the effectiveness between MVD and MVD+PSR in a series of 210 patients. Turk Neurosurg 22(1):32–38

    PubMed  Google Scholar 

  29. Chai Y et al (2013) Predicting the outcome of microvascular decompression for primary trigeminal neuralgia by the use of magnetic resonance tomographic angiography. J Craniofac Surg 24(5):1699–1702

    Article  PubMed  Google Scholar 

  30. Chen MJ et al (2014) Preoperative evaluation of the neurovascular compression using magnetic resonance tomographic angiography: our radiologic indications for microvascular decompression to treat trigeminal neuralgia. J Craniofac Surg 25(4):e384–e388

    Article  PubMed  Google Scholar 

  31. Li GW et al (2014) Clinical characteristics and surgical techniques of trigeminal neuralgia caused simply by venous compression. J Craniofac Surg 25(2):481–484

    Article  PubMed  Google Scholar 

  32. Liao C et al (2016) Microvascular decompression for trigeminal neuralgia: the role of mechanical allodynia. World Neurosurg 91:468–472

    Article  PubMed  Google Scholar 

  33. Dumot C et al (2017) Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien) 159(2):237–249

    Article  PubMed  Google Scholar 

  34. Shi L et al (2017) After microvascular decompression to treat trigeminal neuralgia, both immediate pain relief and recurrence rates are higher in patients with arterial compression than with venous compression. Oncotarget 8(27):44819–44823

    Article  PubMed  PubMed Central  Google Scholar 

  35. Wu M et al (2018) Microvascular decompression for classical trigeminal neuralgia caused by venous compression: novel anatomic classifications and surgical strategy. World Neurosurg 113:e707–e713

    Article  PubMed  Google Scholar 

  36. Deng Z et al (2019) Factors that may affect delayed relief of trigeminal neuralgia after microneurosurgery and the long-term outcomes associated with delayed relief. J Pain Res 12:2817

    Article  PubMed  PubMed Central  Google Scholar 

  37. Inoue T et al (2020) Resection of the suprameatal tubercle in microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 162(5):1089–1094

    Article  PubMed  Google Scholar 

  38. Kasuya H et al (2021) Characteristics and management of the offending veins in microvascular decompression surgery for trigeminal neuralgia. Neurosurg Rev 44(4):2337–2347

    Article  PubMed  Google Scholar 

  39. Mizobuchi Y et al (2021) Microvascular decompression for trigeminal neuralgia: a prospective, multicenter study. Neurosurgery 89(4):557–564

    Article  PubMed  Google Scholar 

  40. Singh D et al (2021) microvascular decompression for trigeminal neuralgia: experience of a tertiary care center in india and a brief review of literature. Neurol India 69(Supplement):S206–s212

    Article  PubMed  Google Scholar 

  41. Song D et al (2021) Effects of preoperative carbamazepine treatment on microvascular decompression for classical trigeminal neuralgia. World Neurosurg 149:e63–e70

    Article  PubMed  Google Scholar 

  42. Wang J et al (2021) Comparative analysis of trigeminal neuralgia caused by sole arterial and venous compression: clinical features and surgical outcomes from 222 cases. Front Neurol 12

  43. Vacca V et al (2014) Higher pain perception and lack of recovery from neuropathic pain in females: a behavioural, immunohistochemical, and proteomic investigation on sex-related differences in mice. PAIN® 155(2):388–402

    Article  PubMed  Google Scholar 

  44. Perrot R et al (2008) Review of the multiple aspects of neurofilament functions, and their possible contribution to neurodegeneration. Mol Neurobiol 38(1):27–65

    Article  CAS  PubMed  Google Scholar 

  45. Holste K et al (2020) Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery 86(2):182

    Article  PubMed  Google Scholar 

  46. Santo Neto H, Camilli JA, Marques MJ (2005) Trigeminal neuralgia is caused by maxillary and mandibular nerve entrapment: greater incidence of right-sided facial symptoms is due to the foramen rotundum and foramen ovale being narrower on the right side of the cranium. Med Hypotheses 65(6):1179–1182

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to all those who have helped us to accomplish and fulfil this project.

Author information

Authors and Affiliations

  1. Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

    Mahla Esmaeilzadeh

  2. Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA

    Mohammadmahdi Sabahi, Rocco Dabeco & Badih Adada

  3. Neurosurgery Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Seyed Farzad Maroufi

  4. Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Seyed Farzad Maroufi

  5. Department of Neurosurgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE

    Florian Roser & Hamid Borghei-Razavi

  6. Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Hamid Borghei-Razavi

Authors
  1. Mahla Esmaeilzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammadmahdi Sabahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyed Farzad Maroufi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rocco Dabeco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Badih Adada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Florian Roser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hamid Borghei-Razavi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hamid Borghei-Razavi.

Ethics declarations

Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Consent to participate

Informed consent to participate in this study was obtained from participants included in the study.

Consent for publication

All authors give their consent to submission of this article to Neurological Sciences.

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

Video Legend. Intraoperative dissection of the superior cerebellar artery (SCA) from trigeminal nerve cisternal segment and placement of Teflon sponge between artery and nerve. Despite the very clear arterial findings in the surgery, the patient had not been experiencing any improvement until 2.5 months. (MP4 4418 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

Esmaeilzadeh, M., Sabahi, M., Maroufi, S.F. et al. When the nerve keeps firing: an institutional experience and systematic review on delayed response after microvascular decompression for trigeminal neuralgia. Neurol Sci 45, 109–118 (2024). https://doi.org/10.1007/s10072-023-07019-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-023-07019-w

Keywords

Search

Navigation