Patient Reports of Satisfaction after Microvascular Decompression and Partial Sensory Rhizotomy for Trigeminal Neuralgia

Oral Medicine, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, England.
Neurosurgery (Impact Factor: 3.62). 07/2005; 56(6):1304-11; discussion 1311-2. DOI: 10.1227/01.NEU.0000159883.35957.E0
Source: PubMed


There are no reports of patient satisfaction surveys after either a microvascular decompression (MVD) or a partial sensory rhizotomy (PSR) for trigeminal neuralgia. This study compares patient satisfaction after these two types of posterior fossa surgery for trigeminal neuralgia, because it is postulated that recurrences, complications, and previous surgical experience reduce satisfaction.
All patients who had undergone their first posterior fossa surgery at one center were sent a self-complete questionnaire by an independent physician. Among the 44 questions on four standardized questionnaires were 5 questions that related to patient satisfaction and experience of obtaining care. Patients were divided into those having their first surgical procedure (primary) and those who had had previous ablative surgery (nonprimary).
Response rates were 90% (220 of 245) of MVD and 88% (53 of 60) of PSR patients. Groups were comparable with respect to age, sex, duration of symptoms, mean duration of follow-up, and recurrence rates. Overall satisfaction with their current situation was 89% in MVD and 72% in PSR patients. Unsatisfied with the outcome were 4% of MVD and 20% of PSR patients, and this is a significant difference (P < 0.01). Satisfaction with outcome was higher in those undergoing this as a primary procedure. In the primary group, satisfaction was dependent on recurrence and complication/side effects status (each P < 0.01), but this was not the case in the nonprimary group. Patients expressed a desire for earlier posterior fossa surgery in 73% of MVD and 58% of PSR patients, and this was highest in the primary group. The final outcome was considered to be better than expected in 80% of MVD and 54% of PSR patients, but 22% of the PSR group (P < 0.01) thought they were worse off.
Patients undergoing posterior fossa surgery as a primary procedure are most satisfied and PSR patients are least satisfied, partly because of a higher rate of side effects.

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Available from: Joanna M. Zakrzewska
    • "In addition, small veins and arteries can also cause trigeminal neuralgia.[131624] Trigeminal MVD can effectively relieve the pain among patients with typical trigeminal neuralgia when vascular compression of the TN is found and adequately solved at surgery.[459293234] However, any surgical procedure for posterior fossa exploration associates risks, especially among aged patients. "
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    ABSTRACT: Trigeminal neuralgia is most commonly caused by vascular compression at the trigeminal nerve (TN) root entry zone. Microvascular decompression (MVD) has been established as a useful treatment. Outcome depends on the correct identification of the compression site and its adequate decompression at surgery. Preoperative identification of neurovascular compression might predict which patients will benefit from MVD. Management of persistent or recurrent trigeminal neuralgia after an MVD is a baffling problem for neurosurgeons. An accurate neuroradiological evaluation of the TN padding following a failed MVD might help identify the underlying cause and plan further treatment. A 68-year-old female presented with a right-sided trigeminal neuralgia (V3) refractory to medical therapy. A high-resolution three-dimensional magnetic resonance imaging (3D MRI) study included fast imaging employing steady-state acquisition (FIESTA) and time of flight multiple overlapping thin slab acquisition (TOF MOTSA) sequences to evaluate the neurovascular anatomy in the cerebellopontine angle. An unambiguous compression of the right TN at the rostral-medial site by the superior cerebellar artery (SCA) was identified. The SCA loop compressing the TN was identical in location and configuration to that predicted in the preoperative study. After the MVD, the patient was relieved from her pain and a postoperative high-resolution 3D MRI study confirmed the appropriate placement of the Teflon implant between the TN and SCA. To our knowledge, this is the first report that characterizes the proper TN padding by high-resolution 3D MRI after trigeminal MVD. The present case also emphasizes the importance of performing a 3D MRI in patients with trigeminal neuralgia to anticipate the surgeon's view and predict the outcome after MVD.
    No preview · Article · May 2012 · Surgical Neurology International
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    • "Vascular compression of the trigeminal nerve root is known as one of the major etiological aspects of trigeminal neuralgia [21-23]. In patients with this disorder, prolonged pain can be alleviated by surgical micro-vascular decompression [21,24,25]. Although these reports have suggested that the trigeminal nerve root plays an important role in the underlying pathophysiology of trigeminal neuralgia, the etiological roles of vascular compression are inferred from clinical observations rather than from experimental manipulation. "
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    ABSTRACT: We investigated the role of the central NMDA receptor NR2 subunits in the modulation of nociceptive behavior and p-p38 MAPK expression in a rat model with compression of the trigeminal nerve root. To address this possibility, changes in air-puff thresholds and pin-prick scores were determined following an intracisternal administration of NR2 subunit antagonists. We also examined effects of NR2 subunit antagonists on the p-p38 MAPK expression. Experiments were carried out using male Sprague-Dawley rats weighing (200-230 g). Compression of the trigeminal nerve root was performed under pentobarbital sodium (40 mg/kg) anesthesia. Compression of the trigeminal nerve root produced distinct nociceptive behavior such as mechanical allodynia and hyperalgesia. Intracisternal administration of 10 or 20 μg of D-AP5 significantly increased the air-puff threshold and decreased the pin-prick scores in a dose-dependent manner. The intracisternal administration of PPPA (1, 10 μg), or PPDA (5, 10 μg) increased the air-puff threshold and decreased the pin-prick scores ipsilateral as well as contralateral to the compression of the trigeminal root. Compression of the trigeminal nerve root upregulated the expression of p-p38 MAPK in the ipsilateral medullary dorsal horn which was diminished by D-AP5, PPPA, PPDA, but not Ro25-6981. Our findings suggest that central NMDA receptor NR2 subunits play an important role in the central processing of trigeminal neuralgia-like nociception in rats with compression of the trigeminal nerve root. Our data further indicate that the targeted blockade of NR2 subunits is a potentially important new treatments strategy for trigeminal neuralgia-like nociception.
    Full-text · Article · Jun 2011 · Molecular Pain
    • "The surgical options for TN include percutaneous procedures such as differential thermal rhizolysis, retrogasserian glycerol rhizolysis, trigeminal ganglion compression, stereotactic radiosurgery (Gamma Knife)[9] and microvascular decompression (MVD).[1011] MVD is a widely used procedure and is reported to provide a pain free status in 70–80% cases of typical TN. "
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    ABSTRACT: Trigeminal neuralgia (TN) is by no means an uncommon entity presenting as typical or atypical pain syndrome with a standard treatment protocol consisting of medical and surgical therapies. The diagnosis of TN is mainly dependent on the characteristics of symptoms conveyed by the patient and the clinical presentation. Careful history taking, proper interpretation of the signs and symptoms and cranial nerve assessment are necessary for proper diagnosis. Here, we report a case of TN, treated for dental problems and then for neuralgia with only short-term relief. Subsequently, the patient underwent neuroimaging and was found to be having an uncommon space-occupying lesion in the posterior cranial fossa.
    No preview · Article · Apr 2010
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