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  • Neurovascular Compression Does not Affect the Efficacy of Percutaneous Radiofrequency Rhizotomy in Trigeminal Neuralgia Patients

    Final Number:

    Chih-Hao Kao MD; Yuan-Hsiung Tsai; Ming-Hsueh Lee; Wei-Chao Huang; Ping-Jui Tsai; Yu-Jen Kuo; Wei-Yuan Cheng MD; Chien-Wei Liao; Jen-Tsung Yang

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: It has been suggested that neurovascular compression in root entry or exit zone may play a role in surgical outcome of trigeminal neuralgia, especially in microvascular decompression. In this study, we investigated whether neurovascular compression caused different results in patients receiving percutaneous radiofrequency rhizotomy.

    Methods: Thirty-one patients with classical trigeminal neuralgia receiving percutaneous radiofrequency rhizotomy were retrospectively examined. All the patients had brain MRI before the procedure to evaluate the neurovascular compression. The pain intensity was measured on a Numerical rating scale (NRS) before and after operation. The duration of the illness and demographic characteristics were recorded and reviewed. All the patients were followed up at our neurosurgical clinic for at least one year.

    Results: Thirty-one patients with trigeminal neuralgia with or without neurovascular compression, 15 and 16 respectively, were included. All the patients had significant improvement in NRS (mean 7.74 ± 2.816) one year after the procedure. However, there was no difference between the two groups (7.81±2.664 without compression vs. 7.67±3.063 with compression, p=0.609).

    Conclusions: Neurovascular compression has been the speculated cause to trigeminal neuralgia. However, it is neither necessary nor sufficient for patients with trigeminal neuralgia. To date, there has not been a definite pre-procedural study that can guide the choice of trigeminal neuralgia. For microvascular decompression, it is important to emphasize the impact of the blood vessel on the nerve which possibly predicts the pain relief after the surgery. Our study demonstrates that percutaneous radiofrequency rhizotomy is equally effective in patients with trigeminal neuralgia either with neurovascular compression or not.

    Patient Care: It is not necessary to differentiate if the patient has neurovascular compression when percutaneous radiofrequency rhizotomy is considered for treating classic trigeminal neuralgia. Unlike microvascular decmopression, Our study shows that percutaneous radiofrequency rhizotomy is equally effective for patients with or without neurovascular compression.

    Learning Objectives: 1. Acknowledge the importance of neurovascular compression in classic trigeminal neuralgia 2. Familiarize the treatment choice of classic trigeminal neuralgia including microvascular decompression, rhizotomy and radiosurgery 3. Learn that neurovascular compression does not affect the efficacy of percutaneous radiofrequency rhizotomy in treating classic trigeminal neuralgia

    References: 1. Erbay, S. H., et al. (2006). "Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia." Neuroradiology 48(1): 26-30. 2. Hughes, M. A., et al. (2016). "MRI of the Trigeminal Nerve in Patients With Trigeminal Neuralgia Secondary to Vascular Compression." AJR Am J Roentgenol 206(3): 595-600. 3. Jo, K. W., et al. (2013). "Long-term prognostic factors for microvascular decompression for trigeminal neuralgia." J Clin Neurosci 20(3): 440-445. 4. Ko, A. L., et al. (2015). "Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression." J Neurosurg 123(6): 1519-1527 5. Maarbjerg, S., et al. (2015). "Significance of neurovascular contact in classical trigeminal neuralgia." Brain 138(Pt 2): 311-319. 6. Peker, S., et al. (2009). "Vascular compression of the trigeminal nerve is a frequent finding in asymptomatic individuals: 3-T MR imaging of 200 trigeminal nerves using 3D CISS sequences." Acta Neurochir (Wien) 151(9): 1081-1088. 7. Sindou, M., et al. (2006). "Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients." Acta Neurochir (Wien) 148(12): 1235-1245; discussion 1245.

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