Letter: Primary Modality for Medically Refractory Trigeminal Neuralgia: Microvascular Decompression or Gamma Knife Therapy?

2017 ◽  
Vol 14 (2) ◽  
pp. E31-E32
Author(s):  
Ravi Sharma ◽  
Varidh Katiyar ◽  
Hitesh Gurjar
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Therapy ◽  
Primary Modality

scholarly journals Comparison of Microvascular Decompression and Two Isocenters Gamma Knife for the Treatment of Trigeminal Neuralgia Caused by Vertebrobasilar Dolichoectasia

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhen Zhao ◽  
SongShan Chai ◽  
JiaJing Wang ◽  
XiaoBing Jiang ◽  
ChuanSheng Nie ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Outcomes ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Radiosurgery ◽  
Therapeutic Effects ◽  
Imaging Data ◽  
Vertebrobasilar Dolichoectasia ◽  
Surgical Methods ◽  
Facial Numbness

Background: Vertebrobasilar dolichoectasia (VBD) is one of the rare causes of trigeminal neuralgia (TN). The common surgical treatments for patients with TN caused by VBD (VBD-TN) are microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS). However, the therapeutic effects of the two methods have not been clinically compared, so this study was performed to evaluate the treatment outcomes of MVD and GKRS for patients with VBD-TN.Methods: The retrospective study was performed from March 2011 to March 2019 in Wuhan Union Hospital. A total of 80 patients diagnosed with VBD-TN were included in this study, and they were divided into the MVD group (n = 46) and GKRS group (n = 34) according to the surgical methods. The imaging data, intraoperative findings, treatment outcomes, and complications of the two groups were analyzed and compared. Meanwhile, the influencing factors of the treatment effect are also explored on the two groups.Results: Patients who underwent MVD were younger than patients who underwent GKRS (median ages were 61.1 and 65.4 years old, respectively, p = 0.03). The median follow-up was 61.1 months for the MVD group and 56.8 months for the GKRS group. The favorable outcomes [Barrow Neurological Institute (BNI) pain score, BNI scores I–II] occurred in 97.8% of patients treated with MVD and in 78.9% of patients treated with GKRS (p = 0.009). The favorable outcomes in the percentage of patients after MVD 1, 3, 5, and 7 years were 95.7, 85.1, 74.2, and 74.2%, respectively, whereas the corresponding percentages after GKRS were 76.5, 66.2, 56.6, and 47.2%, respectively (p = 0.031). The postoperative complications (except facial numbness) in the MVD group were higher than those in the GKRS group (p = 0.036), but the incidence of new and worsening facial numbness was lower in the GKRS group (p < 0.001).Conclusions: MVD is superior to GKRS in obtaining and maintaining favorable outcomes for patients with VBD-TN, but it also comes with more complications other than facial numbness. Thus, the treatment program can be tailored to a patient's unique condition and wishes.

A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 160-172 ◽  
Author(s):  
Mark E. Linskey ◽  
Vaneerat Ratanatharathorn ◽  
Jose Peñagaricano
Keyword(s):  
Cohort Study ◽  
Patient Satisfaction ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Prospective Cohort Study ◽  
Microvascular Decompression ◽  
Prospective Cohort ◽  
Gamma Knife Surgery ◽  
Free Status

Object The aim of this study was to analyze 1 surgeon's 4-year experience with microvascular decompression ([MVD], 36 patients) and Gamma Knife surgery ([GKS], 44 patients) in 80 consecutive patients with trigeminal neuralgia (TN). Methods The authors conducted a prospective cohort study from March 1999 to December 2003 with an independent clinical assessment of the results and serial patient satisfaction surveys. All patients completed a 2004 patient satisfaction survey (0.5–5 years postoperative), and 70% of surviving patients completed the same survey in 2007 (3.9–8.5 years postoperative). Follow-up was undertaken in 100% of the patients (mean 3.4 ± 2.14 years, range 0.17–8.5 years). Results Respective initial and latest follow-up raw pain-free rates were 100 and 80.6% for MVD and 77.3 and 45.5% for GKS. The median time to the maximal benefit after GKS was 4 weeks (range 1 week–6 months). Respective initial, 2-, and 5-year actuarial pain-free rates were 100, 88, and 80% for MVD and 78, 50, and 33% for GKS (p = 0.0002). The relative risk of losing a pain-free status by 5 years posttreatment was 3.35 for patients in the GKS group compared with the MVD group. Initial and 5-year actuarial rates for ≥ 50% pain relief after GKS were 100 and 80%, respectively. The respective rates of permanent mild and severe sensory loss were 5.6 and 0% for patients in the MVD group, as opposed to 6.8 and 2.3% for patients in the GKS group. Anesthesia dolorosa did not occur during the study. Both procedures enjoyed a high degree of early patient satisfaction (95–100%). Microvascular decompression maintained the same rate of patient satisfaction, but satisfaction with GKS decreased to 75% as pain control waned. Twenty-three patients (29%) died of causes unrelated to the TN or the surgical intervention during the follow-up, and their pain status was known at the time of death. Statistically significant intergroup differences for the MVD versus GKS cohorts were age (median 54 years, range 36–70 years vs median 74 years, range 48–92 years, respectively), preoperative symptom duration (median 2.58 years, range 0.33–15 years vs median 7.5, range 0.6–40 years, respectively), and the presence of major comorbidities (2.8 vs 58.3%, respectively). Conclusions In this nonrandomized prospective cohort trial of selected patients with potentially relevant intergroup differences, MVD was significantly superior to GKS in achieving and maintaining a pain-free status in those with TN and provided similar early and superior longer-term patient satisfaction rates compared with those for GKS. The complications of wound cerebrospinal fluid leakage, hearing loss, and persistent diplopia (1 case each in the MVD group) were not seen after GKS.

Microvascular decompression after gamma knife surgery for trigeminal neuralgia: intraoperative findings and treatment outcomes

2005 ◽  
Vol 102 ◽  
pp. 259-261 ◽  
Author(s):  
Andrew G. Shetter ◽  
Joseph M. Zabramski ◽  
Burton L. Speiser
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Contact Point ◽  
Gamma Knife Surgery ◽  
Superior Cerebellar Artery ◽  
Single Individual ◽  
Success Rates ◽  
Content Type ◽  
Fine Print

Object. The authors sought to determine whether the results of trigeminal microvascular decompression (MVD) are influenced by prior gamma knife surgery (GKS). Methods. Gamma knife surgery is an established procedure for treating medically intractable trigeminal neuralgia but failures do occur. The authors assessed six patients (two men and four women; mean age 52 years) who experienced pain recurrence after GKS and elected to undergo trigeminal MVD via retrosigmoid craniotomy. Three patients underwent a single GKS to a maximal dose of 80 Gy, whereas three others underwent a second GKS to total of 120 to 135 Gy. At surgery, none of the six patients demonstrated excess arachnoid thickening, grossly apparent changes in the nerve itself, or any other tissue alterations that made successful mobilization of a blood vessel from the trigeminal root entry zone technically more difficult. A single individual had a small atherosclerotic plaque in the superior cerebellar artery near its contact point with the trigeminal nerve. Follow up at a mean of 25.4 months (range 7.5–42 months) indicated that five patients were pain free. One patient had improved but still relied on medications for pain control. Conclusions. In the authors' experience, trigeminal MVD can be performed without added difficulty in patients who have previously undergone GKS. The success rates seem similar to those normally associated with MVD. Patients who elect the less invasive option of GKS can be assured that trigeminal MVD remains a viable alternative at a later date if further surgery is required.

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