title: Are the destructive neurosurgical techniques as effective as microvascular decompression in the management of trigeminal neuralgia?
abstract: BACKGROUND
  There are no randomized controlled trials comparing TC, PTGC, and MVD for idiopathic TN at a single institution using quality criteria. The aim of the study was to assess the long-term outcome (efficiency and morbidity) of treated patients with one of these techniques in the same institution.
  
  
  METHODS
  The authors present a retrospective study of 165 consecutive patients from 1983 to 2004. The inclusion criteria were drug-resistant idiopathic TN and intolerance to medical treatment. Three groups were set up according to the techniques used: group I (n = 73), treated by TC; group II (n = 41), treated by PTGC; group III (n = 51), treated by MVD. The main judgment criterion was pain relief. The second judgment criterion was morbidity. chi(2) or Fisher exact test, Kaplan-Meier, and log-rank were used for statistical analysis.
  
  
  RESULTS
  The 3 groups were homogeneous according to age, duration of evolution, and pain topography. Concerning sex, groups I and II were different (women, 58%; vs. 37%; P = .021). The immediate efficiency for the 3 groups was, respectively, 96%, 94%, and 95% (NS). At 6 years follow-up, 70%, 77%, and 72% of the patients, respectively, remained pain-free (NS). As determined by the Kaplan-Meier survival curve, there was no difference between the 3 groups (log-rank, P = .867). Hypoesthesia was more frequent for PTGC (89%).
  
  
  CONCLUSIONS
  In our study, we did not find MVD to be more effective than the other techniques. However, it had the lowest long-term complication rate, which is a strong argument in choosing this technique as the initial procedure for young and healthy patients. Percutaneous techniques, however, are still recommended in specific circumstances.
authors.affiliation: Department of Neurosurgery, Hôpital des spécialités O.N.O, C.H.U Rabat, Morocco. mehdi_laghmari@hotmail.com
authors.forename: Mehdi
authors.initials: M
authors.lastname: Laghmari
authors.forename: Abdessamad
authors.initials: A
authors.lastname: El Ouahabi
authors.forename: Yasser
authors.initials: Y
authors.lastname: Arkha
authors.forename: Said
authors.initials: S
authors.lastname: Derraz
authors.forename: Abdeslam
authors.initials: A
authors.lastname: El Khamlichi
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D002404:Catheterization; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D019051:Rhizotomy; D013997:Time Factors; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000601:surgery*