title: Clinical features and long-term surgical outcomes in 39 patients withtumor-related trigeminal neuralgia compared with 360 patients with idiopathic trigeminal neuralgia.
abstract: OBJECTIVE
  The purpose of this study was to compare clinical features, long-term surgical outcomes between patients with idiopathic and tumor-related trigeminal neuralgia (TN), and to identify factors associated with the maintenance of permanent pain-free state.
  
  
  METHODS
  Between January 2003 and December 2013, 360 patients with idiopathic TN and 39 patients with tumor-related TN who had undergone microsurgery were retrospectively studied. Kaplan-Meier survival curves were generated and compared by Log-rank test, and the possible prognostic factors were analyzed by the Cox proportional-hazards regression.
  
  
  RESULTS
  Patients with tumor-related TN exhibited a younger age of pain onset (46.28 ± 18.18y vs. 53.03 ± 11.90y, p = .006), a briefer symptom duration (3.20 ± 4.38y vs. 7.01 ± 6.04y, p = .000), and much more preoperative neuropathic deficits (61.54%% vs. 24.17%%, p = .000), as compared with patients with idiopathic TN. Using Kaplan-Meier analysis, we found microsurgery was effective in 72.3% of patients with idiopathic TN, and in 86.4% of cases with tumor-related TN at six years follow-up postoperatively. Prognostic analysis suggested that a clear-cut neurovascular compression in patients with idiopathic TN (HR = 3.098, 95%CI: 1.800-5.311; p = .000) and total tumor removal in patients with tumor secondary TN (HR = 7.662, 95%CI: 0.098-36.574; p = .044) were positively correlated with excellent long-term outcomes.
  
  
  CONCLUSIONS
  The occurrences of TN at younger age, a shorter duration and preponderance of preclinical neuropathic symptoms are the characteristics of TN patients secondary to intracranial tumor, in contrast to patients with TN caused by a compressed vessel. Microsurgery is an effective and safe treatment modality for TN regardless of the disease etiology, the involvement of a clear-cut vascular offender and total tumor resection are the most important predictors of excellent outcome for microsurgery in idiopathic and tumor-related TN patients, respectively.
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Yongxu
authors.initials: Y
authors.lastname: Wei
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Zhao
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Chunhua
authors.initials: C
authors.lastname: Pu
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cai
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Hanbing
authors.initials: H
authors.lastname: Shang
authors.affiliation: a Department of Neurosurgery , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Wenlei
authors.initials: W
authors.lastname: Yang
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000150:complications*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult
keywords: Trigeminal neuralgia; microsurgery; neurovascular compression; outcome; tumor