Clinical efficacy of MVD combined with PSR in the treatment of primary trigeminal neuralgia

Guangyu Zhao, Xiaojun Sun, Zhen Zhang, Hongan Yang, Xiangrong Zheng, Bin Feng, Guangyu Zhao, Xiaojun Sun, Zhen Zhang, Hongan Yang, Xiangrong Zheng, Bin Feng

Abstract

Clinical efficacy of microvascular decompression (MVD) combined with percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of primary trigeminal neuralgia was investigated. The medical records of 141 patients with primary trigeminal neuralgia admitted to Shandong Provincial Hospital from May 2011 to June 2013 were collected. Among them, 63 patients received MVD surgery and were set as group A, while the other 78 received MVD combined with PSR and were as group B. The efficacy and complication of the two treatment methods were compared. Multivariate logistic regression was performed to analyze the risk factors for treatment efficacy. The total effective rate was 96.15% in group B, higher than that in group A (88.89%), but the difference was not statistically significant (P>0.05). The complications in group B were statistically less than that in group A (P<0.05). Risk factors for the onset of primary trigeminal neuralgia included the degree of decompression, duration of disease, degree of compression, and clinical symptoms. Patients treated with MVD combined with PSR had a better quality of life and lower 5-year recurrence rate than patients treated with MVD (both P<0.05). In conclusion, MVD combined with PSR treatment has good clinical efficacy in primary trigeminal neuralgia and low incidence of complications. The possible risk factors for the onset of primary trigeminal neuralgia include the degree of decompression, duration of disease, degree of compression, and clinical symptoms.

Keywords: MVD; PSR; primary trigeminal neuralgia.

Copyright: © Zhao et al.

Figures

Figure 1
Figure 1
Five-year recurrence in two groups of patients. All patients underwent a 5-year follow-up, with a total recurrence rate of 19.86%. The 5-year recurrence rate was 28.57% in group A, 12.82% in group B. The 5-year recurrence rate was lower in group B than that in group A (P=0.022).

References

    1. Moore D, Chong MS, Shetty A, Zakrzewska JM. A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth. 2019;123:e385–e396. doi: 10.1016/j.bja.2019.05.026.
    1. Zhang YP, Wang Y, Xia WG, Song AQ. Triple Puncture for primary trigeminal neuralgia: A randomized clinical trial. Curr Med Sci. 2019;39:638–644. doi: 10.1007/s11596-019-2085-4.
    1. Hu H, Chen L, Ma R, Gao H, Fang J. Acupuncture for primary trigeminal neuralgia: A systematic review and PRISMA-compliant meta-analysis. Complement Ther Clin Pract. 2019;34:254–267. doi: 10.1016/j.ctcp.2018.12.013.
    1. Pokhrel D, Sood S, McClinton C, Saleh H, Badkul R, Jiang H, Stepp T, Camarata P, Wang F. Linac-based stereotactic radiosurgery (SRS) in the treatment of refractory trigeminal neuralgia: Detailed description of SRS procedure and reported clinical outcomes. J Appl Clin Med Phys. 2017;18:136–143. doi: 10.1002/acm2.12057.
    1. Qin ZL, Yang LQ, Li N, Yue JN, Wu BS, Tang YZ, Guo YN, Lai GH, Ni JX. Clinical study of cerebrospinal fluid neuropeptides in patients with primary trigeminal neuralgia. Clin Neurol Neurosurg. 2016;143:111–115. doi: 10.1016/j.clineuro.2016.02.012.
    1. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289–299. doi: 10.2147/TCRM.S37592.
    1. Wolf A, Kondziolka D. Trigeminal neuralgia and other facial neuralgias. Prog Neurol Surg. 2019;34:273–278. doi: 10.1159/000493074.
    1. Marchetti M, Pinzi V, De Martin E, Ghielmetti F, Fariselli L. Radiosurgery for trigeminal neuralgia: The state of art. Neurol Sci. 2019;40 (Suppl 1):153–157. doi: 10.1007/s10072-019-03814-6.
    1. Ding Y, Li H, Hong T, Zhu Y, Yao P, Zhou G. Combination of pulsed radiofrequency with continuous radiofrequency thermocoagulation at low temperature improves efficacy and safety in V2/V3 primary trigeminal neuralgia. Pain Physician. 2018;21:E545–E553.
    1. Chen ZW, Ma JB, Xie KY, Huang B, Yao M, Fei Y, Zhang L. A study of the relations of foramen rotundum structure direction and the approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia. Zhonghua Yi Xue Za Zhi. 2018;98:436–439. doi: 10.3760/cma.j.issn.0376-2491.2018.06.008. (In Chinese)
    1. Liang C, Wang XY, Li J, Zhang M, Liu HF. Modified backward avulsion used in the treatment of third-branch primary trigeminal neuralgia. J Craniofac Surg. 2018;29:e87–e90. doi: 10.1097/SCS.0000000000004185.
    1. Mistry AM, Niesner KJ, Lake WB, Forbes JA, Shannon CN, Kasl RA, Konrad PE, Neimat JS. Neurovascular compression at the root entry zone correlates with trigeminal neuralgia and early microvascular decompression outcome. World Neurosurg. 2016;95:208–213. doi: 10.1016/j.wneu.2016.08.040.
    1. Ma S, Agarwalla PK, van Loveren HR, Agazzi S. Successful microvascular decompression for trigeminal neuralgia secondary to a persistent trigeminal artery. Oper Neurosurg (Hagerstown) 2019;16:18–22. doi: 10.1093/ons/opy043.
    1. Breeze RE, Craig DB. Microvascular decompression for trigeminal neuralgia: A durable, noncompressive technique using teflon secured with mini clip. Oper Neurosurg (Hagerstown) 2019;16:580–582. doi: 10.1093/ons/opy212.
    1. Wang Y, Yang Q, Cao D, Seminowicz D, Remeniuk B, Gao L, Zhang M. Correlation between nerve atrophy, brain grey matter volume and pain severity in patients with primary trigeminal neuralgia. Cephalalgia. 2019;39:515–525. doi: 10.1177/0333102418793643.
    1. Anichini G, Iqbal M, Rafiq NM, Ironside JW, Kamel M. Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature. Surg Neurol Int. 2016;7 (Suppl 14):S415–S420. doi: 10.4103/2152-7806.183520.
    1. Hussain MA, Konteas A, Sunderland G, Franceschini P, Byrne P, Osman-Farah J, Eldridge P. Re-exploration of microvascular decompression in recurrent trigeminal neuralgia and intraoperative management options. World Neurosurg. 2018;117:e67–e74. doi: 10.1016/j.wneu.2018.05.147.
    1. Kang IH, Park BJ, Park CK, Malla HP, Lee SH, Rhee BA. A clinical analysis of secondary surgery in trigeminal neuralgia patients who failed prior treatment. J Korean Neurosurg Soc. 2016;59:637–642. doi: 10.3340/jkns.2016.59.6.637.
    1. Wang DD, Raygor KP, Cage TA, Ward MM, Westcott S, Barbaro NM, Chang EF. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J Neurosurg. 2018;128:68–77. doi: 10.3171/2016.9.JNS16149.
    1. Romanelli P, Conti A, Bianchi L, Bergantin A, Martinotti A, Beltramo G. Image-guided robotic radiosurgery for trigeminal neuralgia. Neurosurgery. 2018;83:1023–1030. doi: 10.1093/neuros/nyx571.
    1. Chen JN, Yu WH, Du HG, Jiang L, Dong XQ, Cao J. Prospective comparison of redo microvascular decompression and percutaneous balloon compression as primary surgery for recurrent trigeminal neuralgia. J Korean Neurosurg Soc. 2018;61:747–752. doi: 10.3340/jkns.2017.0196.
    1. Zhang D, Meng Y, Hai H, Yu XT, Ma YW. Radial extracorporeal shock wave therapy in an individual with primary trigeminal neuralgia: A case report and literature review. Am J Phys Med Rehabil. 2018;97:e42–e45. doi: 10.1097/PHM.0000000000000831.
    1. Zeng YJ, Zhang H, Yu S, Zhang W, Sun XC. Efficacy and safety of microvascular decompression and gamma knife surgery treatments for patients with primary trigeminal neuralgia: A prospective study. World Neurosurg. 2018;116:e113–e117. doi: 10.1016/j.wneu.2018.04.120.
    1. Du Y, Yang D, Dong X, Du Q, Wang H, Yu W. Percutaneous balloon compression (PBC) of trigeminal ganglion for recurrent trigeminal neuralgia after microvascular decompression (MVD) Ir J Med Sci. 2015;184:745–751. doi: 10.1007/s11845-014-1163-7.

Source: PubMed

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