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Microvascular decompression as a second step treatment for trigeminal neuralgia in patients with failed two-isocentre gamma knife radiosurgery

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Abstract

Objective

Subsequent microvascular decompression (MVD) might be affected by the previous two-isocentre gamma knife radiosurgery (GKS) due to the tissue changes caused by its higher dose radiation and larger treatment volume. This study aimed to evaluate the safety and efficacy of MVD as a second step treatment after two-isocentre GKS.

Methods

Between December 2016 and May 2019, data from 19 consecutive trigeminal neuralgia (TN) patients who experienced MVD after failed two-isocentre GKS were collected. The clinical characteristics, intraoperative findings, surgical outcomes and complications were reviewed and compared with 158 patients who underwent MVD as an initial treatment.

Results

Fifteen patients (78.9%) achieved complete pain relief (Barrow Neurological Institute, BNI class I) immediately after surgery and nine patients (47.4%) maintained complete pain relief at the last follow-up, which was similar to patients who underwent initial MVD. The median follow-up period was 36 months. The incidence of new or worsened facial numbness showed no statistical significance between the groups. During surgery, trigeminal nerve atrophy was noted in 9 patients (47.4%), thickened arachnoid in 3 patients (15.8%), atherosclerotic plaque in 3 patients (15.8%) and neurovascular adhesion in 1 patient (5.3%).

Conclusions

MVD remains an effective and safe rescue therapy for patients who elect the minimally invasive treatment with two-isocentre GKS for the first time, without an increased risk of facial numbness.

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Availability of data and material

The data used to support the findings of this study are available from the corresponding author upon request.

Code availability

Not applicable.

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Acknowledgements

I would like to express my gratitude to the department of radiology for providing the valuable image data and surgeons for providing the intraoperative videos.

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Author notes

  1. Jia-jing Wang and Zhen Zhao contributed equally to this work

Authors and Affiliations

  1. Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No.1277, Wuhan, 430022, People’s Republic of China

    Jia-jing Wang, Zhen Zhao, Song-shan Chai, Yi-hao Wang & Wei Xiang

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  1. Jia-jing Wang
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  2. Zhen Zhao
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  4. Yi-hao Wang
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Contributions

Study concept and design: Jia-jing Wang and Song-shan Chai. Data acquisition and analysis: Jia-jing Wang and Zhen Zhao. Writing the first draft: Jia-jing Wang and Zhen Zhao. Revision: Yi-hao Wang and Wei Xiang. Supervision: Wei Xiang. Read and approved final version: all authors.

Corresponding author

Correspondence to Wei Xiang.

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The study received full approval from the ethics committee of Tongji Medical College, Huazhong University of Science and Technology and informed consent was waived due to the retrospective nature of the study.

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Written informed consent for publication was obtained from all participants.

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The authors declare no competing interests.

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Wang, Jj., Zhao, Z., Chai, Ss. et al. Microvascular decompression as a second step treatment for trigeminal neuralgia in patients with failed two-isocentre gamma knife radiosurgery. Neurosurg Rev 45, 783–791 (2022). https://doi.org/10.1007/s10143-021-01587-1

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  • DOI: https://doi.org/10.1007/s10143-021-01587-1

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