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

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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.

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Data availability

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

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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
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Corresponding author

Correspondence to Hamid Borghei-Razavi.

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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.

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

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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)

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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

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