Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single Institution Experience. (16th November 2020)

• Record Type: Journal Article
• Authors: Li, Luyuan; Hitchon, Patrick W
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_534
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Trigeminal neuralgia (TN) is a debilitating disorder characterized by unilateral lancinating facial pain in the distribution of the cranial nerve V. Microvascular decompression (MVD) is the most standard nondestructive surgical procedure for these patients with medically refractory trigeminal neuralgia. Over the past 20 years, less invasive technique such as stereotactic radiosurgery (SRS) has gained increasing popularity. There have been relatively few literatures that directly compare MVD against SRS with large patient cohorts and long-term follow-up. METHODS: The authors reviewed a prospectively collected database of patients undergoing MVD or SRS for type 1 idiopathic TN between 2001 and 2019 at the University of Iowa. Standardized data collection focused on preoperative clinical characteristics and postoperative outcomes, such as Barrow Neurological Institute (BNI) Pain Intensity Score, were collected. RESULTS: In total, 109 patients underwent MVD and 109 patients underwent SRS for TN at our institution. Younger age (57.7) in the MVD group compared to the SRS group (71.8). No complications in the SRS patients. SRS was three times more likely than MVD to cause post-operative facial numbness. Females were 2.6 times more likely to experience post-operative numbness than males. SRS was associated with unfavorable outcome (BNI IIIb-V). On univariate analysis, MVD is associated with favorable outcome (BNI I-IIIa). But multivariate analysis showed that favorable outcome can actually be achieved with either SRS or MVD. CONCLUSION: Both MVD and SRS can achieve favorable outcome for medically refractory TN. Post-operative facial numbness and persistant pain are more likley to occur after SRS.