Article
Preoperative symptom duration is the most influential risk factor for treatment failure following microvascular decompression for trigeminal neuralgia – a European multi-centre study with 1101 patients
Die präoperative Symptomdauer ist der einflussreichste Risikofaktor für das Behandlungsversagen nach mikrovaskulärer Dekompression bei Trigeminusneuralgie – eine europäische multizentrische Studie mit 1101 Patienten
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Published: | June 26, 2020 |
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Outline
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Objective: The gold standard for the treatment of classic trigeminal neuralgia (TN) is carbamazepine. However, the efficacy of carbamazepine is compromised by its adverse effects. Furthermore, after long-term follow-up only 22% of participants still find carbamazepine effective. Aim of this study is to assess the clinical outcome following the surgical treatment of TN and find potential factors for treatment failure.
Methods: A multicenter retrospective data analysis was performed. Primary outcome was the rate of pain free patients at last follow up. The following factors were analyzed as possible risk factors for treatment failure:
- 1.
- Duration of symptoms
- 2.
- surgical experience
- 3.
- Technique: Neurovascular interposition or neurovascular transposition
- 4.
- Number of affected nerve branches
- 5.
- Presence or absence of neurovascular conflict on MRI
- 6.
- Indication for surgery: medical treatment failure (persisting pain) or intolerable adverse effects of the medication.
At final follow up a telephone interview for patients satisfaction was conducted.
Results: 1101 patients from 23 European institutions were analysed. Follow up data was obtained form 1012 (91.9%). 450 patients were male (41%) mean age was 61 years. Mean duration of symptoms until surgery was 70.6 months (5.8 years). From 989 patients with available imaging data 700 (71%) had a visible conflict on the MRI. 68.2% of patients were pain free at last follow up. Facial hypoesthesia was the most common complication and was seen in 18.4% of patients. There were no mortalities. Regression analysis revealed than only preoperative duration of symptoms correlated with treatment failure (p=0.0012). Telephone interview was conducted with 830 (75%) patients. Of Those 693 (84%) were satisfied with surgery and 554 (67%) would have preferred earlier surgery.
Conclusion: Microvascular decompression for trigeminal neuralgia is a safe and effective treatment method and should probably be done early one. A randomized controlled study comparing MVD to best medical management is warranted.