title: Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia.
abstract: OBJECTIVE Trigeminal neuralgia (TN) is characterized by intermittent, paroxysmal, and lancinating pain along the distribution of the trigeminal nerve. Microvascular decompression (MVD) directly addresses compression of the trigeminal nerve. The purpose of this study was to determine whether patients undergoing MVD as their first surgical intervention experience greater pain control than patients who undergo subsequent MVD. METHODS A retrospective review of patient records from 1998 to 2015 identified a total of 942 patients with TN and 500 patients who underwent MVD. After excluding several cases, 306 patients underwent MVD as their first surgical intervention and 175 patients underwent subsequent MVD. Demographics and clinicopathological data and outcomes were obtained for analysis. RESULTS In patients who underwent subsequent MVD, surgical intervention was performed at an older age (55.22 vs 49.98 years old, p < 0.0001) and the duration of symptoms was greater (7.22 vs 4.45 years, p < 0.0001) than for patients in whom MVD was their first surgical intervention. Patients who underwent initial MVD had improved pain relief and no improvement in pain rates compared with those who had subsequent MVD (95.8% and 4.2% vs 90.3% and 9.7%, respectively, p = 0.0041). Patients who underwent initial MVD had significantly lower rates of facial numbness in the pre- and postoperative periods compared with patients who underwent subsequent MVD (p < 0.0001). The number of complications in both groups was similar (p = 0.4572). CONCLUSIONS The results demonstrate that patients who underwent other procedures prior to MVD had less pain relief and a higher incidence of facial numbness despite rates of complications similar to patients who underwent MVD as their first surgical intervention.
authors.affiliation: The Johns Hopkins University School of Medicine, and.
authors.forename: Debebe
authors.initials: D
authors.lastname: Theodros
authors.affiliation: Department of Neurosurgery.
authors.forename: C
authors.initials: C
authors.lastname: Rory Goodwin
authors.affiliation: Department of Neurosurgery.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bender
authors.affiliation: Department of Neurosurgery.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery.
authors.forename: Tomas
authors.initials: T
authors.lastname: Garzon-Muvdi
authors.affiliation: Department of Neurosurgery.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.affiliation: The Johns Hopkins University School of Medicine, and.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abu-Bonsrah
authors.affiliation: Department of Neurosurgery.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mathios
authors.affiliation: Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Blitz
authors.affiliation: Department of Neurosurgery.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.affiliation: Department of Neurosurgery.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Carson
authors.affiliation: Department of Neurosurgery.
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.affiliation: Department of Neurosurgery.
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000150:complications / Q000601:surgery*
keywords: CISS = constructive interference in steady-state; MVD = microvascular decompression; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia; microvascular decompression; pain; trigeminal neuralgia