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Microvascular decompression for classic trigeminal neuralgia recurrence after percutaneous rhizotomy procedures
EANS Academy. Fedirko V. Sep 26, 2019; 276036; EP07025
Abstract
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Background: rhizotomy procedures for classic trigeminal neuralgia (CTN), even being rather successful, have not negligible rate of failure and pain recurrence. Hence it could be necessary to perform another intervention. As available data regarding CTN recurrence's management are very scarce, our study aimed to investigate whether the efficacy and safety of CTN-gold-standard management — microvascular decompression (MVD) were influenced by prior percutaneous rhizotomy procedures (PRP).
Methods: retrospective evaluation of 28 consecutive patients who underwent MVD for CTN recurrence after PRP during 2015-2016 yy. Treatment results, outcomes and intraoperative findings were categorized and statistically analyzed in comparison with control group of 66 MVD patients without any prior procedures. Barrow Neurological Institute (BNI) scores were used.
Results: Operative findings: trigeminal nerve atrophy and decoloration was seen in 9 patients (32%); sick arachnoid adhesions with nerve root distortions - in 13 cases (46,7%); «milky» arachnoid opacity - in 5 (17,8%); no offending vessel detected in 1 case (3,6%). Postoperative average BNI Pain Score was 2,21 not statistically different in comparison with group without prior rhizotomy - 1,95 (significant proportion of BNI Pain Score 3 because of gradual anticonvulsants withdrawal). At last follow-up BNI Pain Score was lower in pure MVD group (1,43 vs 2,43; P = 0,0006 95% CI 0,5918 to 1,9987). BNI Numbness Score and other neuropathy indicators were higher in group with prior rhizotomy (2,5 vs 1,3; P < 0,0001 95% CI 0,6697 to 1,6541). Among them 100% had clinically significant neuropathy and 57% had had dysesthesias in contrast to 27% and 7% in pure MVD group respectively. New or worsened neuropathy signs manifested in 5 patients (17,9%).
Conclusions: Being more pathogenically justified MVD remains the procedure of choice for patients with recurrent CTN after PRP with additional risks of neuropathy, probably caused by destructive nature of rhizotomy procedures.
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