Journal article
Options in treating trigeminal neuralgia: Experience with 195 patients
Clinical neurology and neurosurgery, Vol.149, pp.166-170
10/2016
DOI: 10.1016/j.clineuro.2016.08.016
PMID: 27556293
Abstract
•Women were more frequently affected by TN than men (p=0.045).•MVD is treatment least likely to fail or require additional intervention.•Patients who underwent MVD were younger than those undergoing RF or SRS.•The highest rate of TN recurrence occurred in patients undergoing RF (64%).•Facial numbness was least likely to occur with MVD (16%).
For patients with medically unresponsive trigeminal neuralgia (TN), surgical options include microvascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radiosurgery (SRS). In an attempt to identify the risks and benefits and cost inherent with each of the three modalities, we performed a retrospective review of our experience with 195 cases of TN treated over the past 15 years.
Since 2001, 195 patients with previously untreated TN were managed: with MVD in 79, RF in 36, and SRS in 80. All patients reported herein underwent preoperative MRI. Women outnumbered men 122/73 (p=0.045). Follow-up after surgery was 32±46months.
The patients qualifying for MVD were generally healthier and younger, with a mean age±SD of 57±14, compared to those undergoing RF (75±15) or SRS (73±13, p<0.0001). In case of relapse, medical treatment was always tried and failed prior to consideration of surgical intervention. A second surgical procedure was necessary in 2, 23, and 18 patients initially treated with MVD, RF, and SRS respectively (p<0.0001). In the patients treated with MVD, RF, and SRS, the average number of procedures per patient necessary to achieve pain control was 1.1, 2.0, and 1.3 respectively (p=0.001). There were 7 complications in the patients treated with MVD but no deaths. Numbness was present in 13, 18, and 29 patients treated with MVD, RF, and SRS respectively (p=0.008).
MVD for TN is the treatment least likely to fail or require additional treatment. Patients who underwent MVD were younger than those undergoing RF or SRS. The highest rate of recurrence of TN was encountered in patients undergoing RF (64%). Facial numbness was least likely to occur with MVD (16%) compared to RF and SRS (50% and 36% respectively).
Details
- Title: Subtitle
- Options in treating trigeminal neuralgia: Experience with 195 patients
- Creators
- Patrick W Hitchon - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesMarshall Holland - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesJennifer Noeller - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesMark C Smith - Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesToshio Moritani - Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesNivedita Jerath - Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesWenzhuan He - Department of Neurology and Neurosciences, Rutgers-New Jersey Medical School, Newark, NJ, United States
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.149, pp.166-170
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.clineuro.2016.08.016
- PMID
- 27556293
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Language
- English
- Date published
- 10/2016
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiation Oncology; Neurosurgery
- Record Identifier
- 9984040016402771
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