J Korean Neurosurg Soc.  2021 Nov;64(6):966-974. 10.3340/jkns.2020.0315.

Long Time Efficacy and Safety of Microvascular Decompression Combined with Internal Neurolysis for Recurrent Trigeminal Neuralgia

• Zheng W
• Dong X
• Wang D
• Hu Q
• Du Q

• KMID: 2521987
• DOI: http://doi.org/10.3340/jkns.2020.0315

Abstract

Objective
: To explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD.
Methods
: Sixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed.
Results
: The efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18–36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05).
Conclusion
: A retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of long-term facial numbness and other complications.

Keyword

Trigeminal neuralgia; Microvascular decompression; Neurolysis; Arachnoid

Figure

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  Fig. 1. Internal neurolysis during operation. A : Intraoperative view in patients with recurrent trigeminal neuralgia. B : The internal neurolysis procedure includes separating the trigeminal nerve longitudinally, using a nerve comb knife to comb the trigeminal nerve root from root entry zone to petrous bone in 5–10 levels. C : The final configuration of trigeminal nerve after internal neurolysis.

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  Fig. 2. Kaplan-Meier survival curves comparing the percentage of patients who were pain free off medications after MVD+IN (solid line) and MVD (dashed line). There were no significant differences between the two groups (p>0.05). MVD : microvascular decompression, IN : internal neurolysis.

Reference

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