Long-term evaluation of clinical outcome after microvascular decompression for trigeminal neuralgia – Langzeitauswertung der klinischen Ergebnisse nach mikrovaskulärer Dekompression bei Trigeminusneuralgie

Objective:

The treatment of trigeminal neuralgia using microvascular decompression (MVD) is still challenging regarding postoperative outcome. According to the literature a considerable recurrence rate has been observed. In order to support the quality of the clinical outcome, 3D visualization of the MRI data has been used for our preoperative planning to achieve a detailed understanding of the complex neurovascular relationships at the surface of the brainstem as well as routine intraoperative BAEP and EMG monitoring has been applied to avoid neurological deficits during surgery. The achieved results were analyzed in a current study in the short- and long-term follow-up.

Methods:

In the period 2000 – 2013 a consecutive series of a total of 266 patients underwent surgery of trigeminal neuralgia using MVD. It was evaluated whether the patients were free of pain without or with reduced medication and after a second operation due to recurrence of trigeminal neuralgia, respectively. The clinical outcome after MVD was investigated at discharge and after 1, 3, 5 and 10 years respectively. MVD was performed in 135 cases with and in 131 cases without 3D visualization.

Results:

Concerning the short-term follow-up at discharge 97% of the patients were free of pain without any medication and 2% were free of pain with reduced medication. After 1, 3, 5 and 10 years 95%, 91%, 89% and 83% were free of pain without or with reduced medication respectively. Overall, 19 patients had recurrence of trigeminal neuralgia, 7 of whom were re-operated using MVD with 5 patients being free of pain in the long-term follow-up. Concerning preoperative planning with 3D visualization no statistical significant influence was found on the clinical outcome. However, 3D visualization is rated as reliable tool to safely and accurately guide the surgeon to the site of pathology.

Conclusion:

MVD is a highly effective and low-risk therapy for the treatment of typical trigeminal neuralgia and in comparison to the other therapy methods the best curative treatment option in the long-term follow-up. Our presented results clearly demonstrate a considerable improvement of the clinical outcome in comparison to the literature. Overall, this also shows that our therapy management of trigeminal neuralgia including 3D visualization and intraoperative monitoring is indispensible to achieve high quality results of clinical outcome