Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Surgical Treatment for Trigeminal Neuralgia

  • Park, Chang Kyu (Department of Neurosurgery, College of Medicine, Kyung Hee University) ;
  • Park, Bong Jin (Department of Neurosurgery, College of Medicine, Kyung Hee University)
  • Received : 2021.11.09
  • Accepted : 2022.02.16
  • Published : 2022.09.01
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Abstract

Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a low recurrence rate. Surgical treatment addresses the challenge of vascular compression, which accounts for 85% of the causes of TN. As for surgical treatment for TN, microvascular decompression (MVD) has become the surgical treatment of choice after Peter J. Jannetta reported the results of MVD surgery in 1996. Since then, many studies have reported a success rate of over 90% for the initial surgical treatment. Most MVDs aim to separate (decompress) the culprit vessel from the trigeminal nerve. To increase the success rate of surgery, accurate indications for MVD and management of the offender vessels without complications are critical. In addition, if there is no vascular compression, partial sensory rhizotomy or internal neurolysis can be performed to improve surgical outcomes.

Keywords

References

  1. Abi-Aad KR, Turcotte E, Patra DP, Welz ME, Maiti T, Hess R, et al. : Vascular transposition of the superior cerebellar artery using a fenestrated clip and fibrin glue in trigeminal neuralgia: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 19 : E50-E51, 2020 https://doi.org/10.1093/ons/opz291
  2. Alford EN, Chagoya G, Elsayed GA, Bernstock JD, Bentley JN, Romeo A, et al. : Risk factors for wound-related complications after microvascular decompression. Neurosurg Rev 44 : 1093-1101, 2021 https://doi.org/10.1007/s10143-020-01296-1
  3. Amador N, Pollock BE : Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia. J Neurosurg 108 : 916-920, 2008 https://doi.org/10.3171/JNS/2008/108/5/0916
  4. Ashkan K, Marsh H : Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55 : 840-848, 2004 https://doi.org/10.1227/01.NEU.0000137660.06337.C5
  5. Bakker NA, Van Dijk JM, Immenga S, Wagemakers M, Metzemaekers JD : Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia. J Neurosurg 121 : 936-939, 2014 https://doi.org/10.3171/2014.7.JNS132667
  6. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD : The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334 : 1077-1083, 1996 https://doi.org/10.1056/NEJM199604253341701
  7. Bartindale M, Mohamed A, Bell J, Kircher M, Hill J, Anderson D, et al. : Neurotologic complications following microvascular decompression: a retrospective study. J Neurol Surg B Skull Base 81 : 37-42, 2020 https://doi.org/10.1055/s-0039-1677688
  8. Bayer DB, Stenger TG : Trigeminal neuralgia: an overview. Oral Surg Oral Med Oral Pathol 48 : 393-399, 1979 https://doi.org/10.1016/0030-4220(79)90064-1
  9. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. : European academy of neurology guideline on trigeminal neuralgia. Eur J Neurol 26 : 831-849, 2019 https://doi.org/10.1111/ene.13950
  10. Broggi G, Ferroli P, Franzini A, Servello D, Dones I : Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68 : 59-64, 2000 https://doi.org/10.1136/jnnp.68.1.59
  11. Burchiel KJ : Trigeminal neuralgia. J Neurosurg 112 : 756-757, 2010 https://doi.org/10.3171/2009.8.JNS091061
  12. Chai S, Xu H, Wang Q, Li J, Wang J, Wang Y, et al. : Microvascular decompression for trigeminal neuralgia caused by vertebrobasilar dolichoectasia: interposition technique versus transposition technique. Acta Neurochir (Wien) 162 : 2811-2821, 2020 https://doi.org/10.1007/s00701-020-04572-7
  13. Chakravarthi PS, Ghanta R, Kattimani V : Microvascular decompression treatment for trigeminal neuralgia. J Craniofac Surg 22 : 894-898, 2011 https://doi.org/10.1097/SCS.0b013e31821a07b7
  14. Chen J, Lee S, Lui T, Yeh Y, Chen T, Tzaan W : Teflon granuloma after microvascular decompression for trigeminal neuralgia. Surg Neurol 53 : 281-287, 2000 https://doi.org/10.1016/S0090-3019(00)00169-5
  15. Cheng J, Long J, Hui X, Lei D, Zhang H : Effects of microvascular decompression on depression and anxiety in trigeminal neuralgia: a prospective cohort study focused on risk factors and prognosis. Clin Neurol Neurosurg 161 : 59-64, 2017 https://doi.org/10.1016/j.clineuro.2017.08.011
  16. Cheng J, Meng J, Lei D, Hui X : Repeat microvascular decompression for patients with persistent or recurrent trigeminal neuralgia: prognostic factors and long-term outcomes. Medicine (Baltimore) 98 : e15167, 2019
  17. Cheshire WP Jr : Trigeminal neuralgia. Curr Pain Headache Rep 11 : 69-74, 2007 https://doi.org/10.1007/s11916-007-0025-7
  18. Dandy WE : An operation for the cure of tic douloureux: partial section of the sensory root at the pons. Arch Surg 18 : 687-734, 1929 https://doi.org/10.1001/archsurg.1929.04420030081005
  19. Dandy WE : The treatment of trigeminal neuralgia by the cerebellar route. Ann Surg 96 : 787-795, 1932 https://doi.org/10.1097/00000658-193210000-00026
  20. Degn J, Brennum J : Surgical treatment of trigeminal neuralgia. results from the use of glycerol injection, microvascular decompression, and rhizotomia. Acta Neurochir (Wien) 152 : 2125-2132, 2010 https://doi.org/10.1007/s00701-010-0840-1
  21. Eseonu CI, Goodwin CR, Zhou X, Theodros D, Bender MT, Mathios D, et al. : Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement. J Neurosurg 123 : 1476-1479, 2015 https://doi.org/10.3171/2015.1.JNS142102
  22. Fukushima T : Posterior cranial fossa neurovascular decompression (Jannetta method) for trigeminal neuralgia and facial spasm. No Shinkei Geka 10 : 1257-1261, 1982
  23. Gardner WJ, Miklos MV : Response of trigeminal neuralgia to decompression of sensory root; discussion of cause of trigeminal neuralgia. J Am Med Assoc 170 : 1773-1776, 1959 https://doi.org/10.1001/jama.1959.03010150017004
  24. Gardner WJ, Pinto JP : The tarrnhoj operation; relief of trigeminal neuralgia without numbness. Cleve Clin Q 20 : 364-367, 1953 https://doi.org/10.3949/ccjm.20.2.364
  25. Harris W : A history of the treatment of trigeminal neuralgia. Postgrad Med J 27 : 18-21, 1951 https://doi.org/10.1136/pgmj.27.303.18
  26. Heinskou TB, Maarbjerg S, Wolfram F, Rochat P, Brennum J, Olesen J, et al. : Favourable prognosis of trigeminal neuralgia when enrolled in a multidisciplinary management program - a two-year prospective real-life study. J Headache Pain 20 : 23, 2019
  27. Holste K, Chan AY, Rolston JD, Englot DJ : Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery 86 : 182-190, 2020 https://doi.org/10.1093/neuros/nyz075
  28. Jannetta PJ : Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations. Clin Neurosurg 24 : 538-549, 1977 https://doi.org/10.1093/neurosurgery/24.CN_suppl_1.538
  29. Kabatas S, Karasu A, Civelek E, Sabanci AP, Hepgul KT, Teng YD : Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature. Neurosurg Rev 32 : 87-93, 2009 https://doi.org/10.1007/s10143-008-0171-3
  30. 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 59 : 637-642, 2016 https://doi.org/10.3340/jkns.2016.59.6.637
  31. Kasuya H, Tani S, Kubota Y, Yokosako S, Ohbuchi H, Arai N, et al. : Characteristics and management of the offending veins in microvascular decompression surgery for trigeminal neuralgia. Neurosurg Rev 44 : 2337-2347, 2021 https://doi.org/10.1007/s10143-020-01411-2
  32. Khan SA, Laulloo A, Vats A, Nath F : Microvascular decompression: incidence and prevention of postoperative CSF leakage in a consecutive series of 134 patients. Br J Neurosurg 34 : 416-418, 2020 https://doi.org/10.1080/02688697.2020.1749989
  33. Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ : Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg 122 : 1048-1057, 2015 https://doi.org/10.3171/2014.12.JNS14469
  34. Lee SH, Levy EI, Scarrow AM, Kassam A, Jannetta PJ : Recurrent trigeminal neuralgia attributable to veins after microvascular decompression. Neurosurgery 46 : 356-361, 2000 https://doi.org/10.1097/00006123-200002000-00019
  35. Li GW, Zhang WC, Min Y, Ma QF, Zhong WX : Surgical skills of adhesions and transposition of trigeminal nerve for primary trigeminal neuralgia. J Craniofac Surg 25 : 1296-1298, 2014 https://doi.org/10.1097/SCS.0000000000000746
  36. Li MW, Jiang XF, Niu C : Efficacy of internal neurolysis for trigeminal neuralgia without vascular compression. J Neurol Surg A Cent Eur Neurosurg 82 : 364-368, 2021 https://doi.org/10.1055/s-0041-1723809
  37. Lin CF, Chen HH, Hernesniemi J, Lee CC, Liao CH, Chen SC, et al. : An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression. Clin Neurol Neurosurg 114 : 951-956, 2012 https://doi.org/10.1016/j.clineuro.2012.02.021
  38. Masuoka J, Matsushima T, Kawashima M, Nakahara Y, Funaki T, Mineta T : Stitched sling retraction technique for microvascular decompression: procedures and techniques based on an anatomical viewpoint. Neurosurg Rev 34 : 373-379, 2011 https://doi.org/10.1007/s10143-011-0310-0
  39. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK : Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90 : 1-8, 1999 https://doi.org/10.3171/jns.1999.90.1.0001
  40. Melek LN, Devine M, Renton T : The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg 47 : 869-878, 2018 https://doi.org/10.1016/j.ijom.2018.02.006
  41. Meybodi AT, Habibi Z, Miri M, Tabatabaie SA : Microvascular decompression for trigeminal neuralgia using the 'stitched sling retraction' technique in recurrent cases after previous microvascular decompression. Acta Neurochir (Wien) 156 : 1181-1187, 2014 https://doi.org/10.1007/s00701-014-2092-y
  42. Mitsos AP, Georgakoulias N, Lafazanos SA, Konstantinou EA : The "hanging technique" of vascular transposition in microvascular decompression for trigeminal neuralgia: technical report of four cases. Neurosurg Rev 31 : 327-330, 2008 https://doi.org/10.1007/s10143-008-0144-6
  43. Nunta-Aree S, Patiwech K, Sitthinamsuwan B : Microvascular decompression for treatment of trigeminal neuralgia: factors that predict complete pain relief and study of efficacy and safety in older patients. World Neurosurg 110 : e979-e988, 2018 https://doi.org/10.1016/j.wneu.2017.11.147
  44. Oishi M, Fukuda M, Noto Y, Kawaguchi T, Hiraishi T, Fujii Y : Trigeminal neuralgia associated with the specific bridging pattern of transverse pontine vein: diagnostic value of three-dimensional multifusion volumetric imaging. Stereotact Funct Neurosurg 89 : 226-233, 2011 https://doi.org/10.1159/000326778
  45. Otani N, Toyooka T, Fujii K, Kumagai K, Takeuchi S, Tomiyama A, et al. : "Birdlime" technique using tachosil tissue sealing sheet soaked with fibrin glue for sutureless vessel transposition in microvascular decompression: operative technique and nuances. J Neurosurg 128 : 1522-1529, 2018 https://doi.org/10.3171/2017.1.JNS161243
  46. Otani N, Toyooka T, Takeuchi S, Tomiyama A, Wada K, Mori K : Novel technical variations and increased adhesive strength in the "Birdlime" transposition technique for microvascular decompression. World Neurosurg 116 : e460-e468, 2018 https://doi.org/10.1016/j.wneu.2018.05.006
  47. Phan K, Rao PJ, Dexter M : Microvascular decompression for elderly patients with trigeminal neuralgia. J Clin Neurosci 29 : 7-14, 2016 https://doi.org/10.1016/j.jocn.2015.11.027
  48. Pines AR, Butterfield RJ, Turcotte EL, Garcia JO, De Lucia N, Algier EJ, et al. : Microvascular transposition without teflon: a single institution's 17-year experience treating trigeminal neuralgia. Oper Neurosurg (Hagerstown) 20 : 397-405, 2021 https://doi.org/10.1093/ons/opaa413
  49. Rzaev DA, Kulikova EV, Moysak GI, Voronina EI, Ageeva TA : Teflon granuloma after microvascular decompression of the trigeminal nerve root in a patient with recurrent trigeminal neuralgia. Zh Vopr Neirokhir Im N N Burdenko 80 : 78-83, 2016
  50. Sato O, Kanazawa I, Kokunai T : Trigeminal neuralgia caused by compression of trigeminal nerve by pontine vein. Surg Neurol 11 : 285-286, 1979
  51. Seo HJ, Park CK, Choi MK, Ryu J, Park BJ : Clinical outcome of percutaneous trigeminal nerve block in elderly patients in outpatient clinics. J Korean Neurosurg Soc 63 : 814-820, 2020 https://doi.org/10.3340/jkns.2020.0139
  52. Shibahashi K, Morita A, Kimura T : Surgical results of microvascular decompression procedures and patient's postoperative quality of life: review of 139 cases. Neurol Med Chir (Tokyo) 53 : 360-364, 2013 https://doi.org/10.2176/nmc.53.360
  53. Sindou M, Leston J, Decullier E, Chapuis F : Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107 : 1144-1153, 2007 https://doi.org/10.3171/JNS-07/12/1144
  54. Sindou M, Leston JM, Decullier E, Chapuis F : Microvascular decompression for trigeminal neuralgia: the importance of a noncompressive technique--kaplan-meier analysis in a consecutive series of 330 patients. Neurosurgery 63 : 341-350, 2008
  55. Soni P, Potter T, Soni PP, Estemalik E, Recinos PF, Kshettry VR : Outcomes of microvascular decompression for trigeminal neuralgia with purely venous compression: a systematic review and meta-analysis. Clin Neurol Neurosurg 198 : 106230, 2020
  56. Stoker MA, Forbes JA, Hanif R, Cooper C, Nian H, Konrad PE, et al. : Decreased rate of CSF leakage associated with complete reconstruction of suboccipital cranial defects. J Neurol Surg B Skull Base 73 : 281-286, 2012 https://doi.org/10.1055/s-0032-1312709
  57. Sweet WH : The history of the development of treatment for trigeminal neuralgia. Clin Neurosurg 32 : 294-318, 1985
  58. Taarnhoj P : Trigeminal neuralgia and decompression of the trigeminal root. Surg Clin North Am : 1145-1157, 1956
  59. Taarnhoj P : Decompression of the trigeminal root. J Neurosurg 11 : 299-305, 1954 https://doi.org/10.3171/jns.1954.11.3.0299
  60. Tang X, Wang Y, Shu Z, Hou Y : Efficacy and prognosis of trigeminal neuralgia treated with surgical excision or gamma knife surgery. Zhong Nan Da Xue Xue Bao Yi Xue Ban 37 : 616-620, 2012
  61. Terrier LM, Amelot A, Francois P, Destrieux C, Zemmoura I, Velut S : Therapeutic failure in trigeminal neuralgia: from a clarification of trigeminal nerve somatotopy to a targeted partial sensory rhizotomy. World Neurosurg 117 : e138-e145, 2018 https://doi.org/10.1016/j.wneu.2018.05.211
  62. Theodros D, Rory Goodwin C, Bender MT, Zhou X, Garzon-Muvdi T, De la Garza-Ramos R, et al. : Efficacy of primary microvascular decompression versus subsequent microvascular decompression for trigeminal neuralgia. J Neurosurg 126 : 1691-1697, 2017 https://doi.org/10.3171/2016.5.JNS151692
  63. Tomasello F, Esposito F, Abbritti RV, Angileri FF, Conti A, Cardali SM, et al. : Microvascular decompression for trigeminal neuralgia: technical refinement for complication avoidance. World Neurosurg 94 : 26-31, 2016 https://doi.org/10.1016/j.wneu.2016.06.097
  64. Xia L, Zhong J, Zhu J, Wang YN, Dou NN, Liu MX, et al. : Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg 25 : 1413-1417, 2014 https://doi.org/10.1097/SCS.0000000000000984
  65. Young JN, Wilkins RH : Partial sensory trigeminal rhizotomy at the pons for trigeminal neuralgia. J Neurosurg 79 : 680-687, 1993 https://doi.org/10.3171/jns.1993.79.5.0680
  66. Yue Y, Zhao ZR, Liu DC, Liu HJ, Lu DL, Zhang H, et al. : Life-threatening complications after microvascular decompression procedure: lessons from a consecutive series of 596 patients. J Clin Neurosci 86 : 64-70, 2021 https://doi.org/10.1016/j.jocn.2021.01.014
  67. Zhang D, Barata A, Pires P, Soares P, Marques L : Transposition of superior cerebellar artery for microvascular decompression in trigeminal neuralgia using an in situ superior petrosal vein sling technique. World Neurosurg 134 : 402-407, 2020 https://doi.org/10.1016/j.wneu.2019.11.029