J Korean Neurosurg Soc.  2018 Nov;61(6):747-752. 10.3340/jkns.2017.0196.

Prospective Comparison of Redo Microvascular Decompression and Percutaneous Balloon Compression as Primary Surgery for Recurrent Trigeminal Neuralgia

• Chen JN
• Yu WH
• Du HG
• Jiang L
• Dong XQ
• Cao J

• KMID: 2428117
• DOI: http://doi.org/10.3340/jkns.2017.0196

Abstract

OBJECTIVE
To prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence.
METHODS
Prospective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months.
RESULTS
After redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p < 0.01). Patients who had redo MVD more commonly were pain free off medications (93.4% at 1 year, 78.2% at 4 years) compared with the PBC patients (85.1% at 1 year, 59.3% at 4 years). However, mean length of stay was longer (p>0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), and annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), and hypoesthesia (5.9%) (p < 0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period.
CONCLUSION
For the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.

Keyword

Trigeminal neuralgia; Re-do; Microvascular decompression surgery; Percutaneous balloon compression

MeSH Terms

Cohort Studies
Facial Pain
Follow-Up Studies
Herpes Simplex
Humans
Hypesthesia
Incidence
Length of Stay
Microvascular Decompression Surgery*
Neuralgia
Paresthesia
Prospective Studies*
Recurrence
Trigeminal Neuralgia*

Figure

• 

  Fig. 1. Kaplan-Meier survival curve comparing the percentage of patients who were pain free off medications after redo MVD (solid line) and PBC (dashed line). Patients having redo MVD were more likely to be pain free after surgery (p=0.02). MVD : microvascular decompression, PBC : percutaneous balloon compression.

Reference

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