Arterial hypertension independently predicts recurrence after surgery for trigeminal neuralgia: may a modifiable risk factor be a key component?
EANS Academy. Sousa S. 10/04/21; 339237; EP08023
Dr. Sergio Sousa
Contributions
Contributions
Abstract
Introduction: Microvascular decompression is highly effective for the management of classical refractory trigeminal neuralgia. Nonetheless, predictors of post-operative prognosis are incompletely understood.
Methods: We performed a retrospective analysis of the classical trigeminal neuralgia cases submitted to microvascular decompression in our center between 2003 and 2019. 57 patients were identified and pre-op clinical and imagiological characteristics, surgical findings, complications and pain control – both immediate and long-term – were described. Outcome was measured using the Barrow Neurological Institute Pain Intensity Score (BNIPIS).
Results: Mean age at procedure was 63.9 years, with a female predominance (66.7%). Most symptoms were in the V2 and V3 territory and the most common trigger identified was mastication. History of arterial hypertension was identified in 49.1%. Vascular contact at surgery was identified in almost all patients (97.6%). Regarding pain outcome results, at 6 months post-op, 80.7% of patients had a good outcome [VSP1] (defined as BNIPIS[VSP2] ≤ 3). This result was maintained at 12 months, with 78.9% of patients having a good outcome. At long follow-up (median 77 months), 82.5% of patients had a BNIPIS ≤ 3, with 50% achieving a BNIPIS 1. Recurrence was identified in 37.3% of those patients[VSP3] that experienced initial improvement, at [VSP4] a median of 44 months after surgery. Left sided neurovascular contact (p=0.035) and arterial hypertension (p=0.012) were factors associated with recurrence. On a multivariate analysis, hypertension remained independently associated with recurrence (p=0.035).
Conclusion: Microvascular decompression is a valuable resource for managing refractory trigeminal neuralgia. Factors associated with recurrence are poorly understood. Arterial hypertension, a potentially modifiable risk factor, might be a recurrence predictor, possibly by modulating local vascular phenomena. Better understanding of the pathophysiology involved can provide physicians means to overcome this incapacitating disease.
Methods: We performed a retrospective analysis of the classical trigeminal neuralgia cases submitted to microvascular decompression in our center between 2003 and 2019. 57 patients were identified and pre-op clinical and imagiological characteristics, surgical findings, complications and pain control – both immediate and long-term – were described. Outcome was measured using the Barrow Neurological Institute Pain Intensity Score (BNIPIS).
Results: Mean age at procedure was 63.9 years, with a female predominance (66.7%). Most symptoms were in the V2 and V3 territory and the most common trigger identified was mastication. History of arterial hypertension was identified in 49.1%. Vascular contact at surgery was identified in almost all patients (97.6%). Regarding pain outcome results, at 6 months post-op, 80.7% of patients had a good outcome [VSP1] (defined as BNIPIS[VSP2] ≤ 3). This result was maintained at 12 months, with 78.9% of patients having a good outcome. At long follow-up (median 77 months), 82.5% of patients had a BNIPIS ≤ 3, with 50% achieving a BNIPIS 1. Recurrence was identified in 37.3% of those patients[VSP3] that experienced initial improvement, at [VSP4] a median of 44 months after surgery. Left sided neurovascular contact (p=0.035) and arterial hypertension (p=0.012) were factors associated with recurrence. On a multivariate analysis, hypertension remained independently associated with recurrence (p=0.035).
Conclusion: Microvascular decompression is a valuable resource for managing refractory trigeminal neuralgia. Factors associated with recurrence are poorly understood. Arterial hypertension, a potentially modifiable risk factor, might be a recurrence predictor, possibly by modulating local vascular phenomena. Better understanding of the pathophysiology involved can provide physicians means to overcome this incapacitating disease.
Introduction: Microvascular decompression is highly effective for the management of classical refractory trigeminal neuralgia. Nonetheless, predictors of post-operative prognosis are incompletely understood.
Methods: We performed a retrospective analysis of the classical trigeminal neuralgia cases submitted to microvascular decompression in our center between 2003 and 2019. 57 patients were identified and pre-op clinical and imagiological characteristics, surgical findings, complications and pain control – both immediate and long-term – were described. Outcome was measured using the Barrow Neurological Institute Pain Intensity Score (BNIPIS).
Results: Mean age at procedure was 63.9 years, with a female predominance (66.7%). Most symptoms were in the V2 and V3 territory and the most common trigger identified was mastication. History of arterial hypertension was identified in 49.1%. Vascular contact at surgery was identified in almost all patients (97.6%). Regarding pain outcome results, at 6 months post-op, 80.7% of patients had a good outcome [VSP1] (defined as BNIPIS[VSP2] ≤ 3). This result was maintained at 12 months, with 78.9% of patients having a good outcome. At long follow-up (median 77 months), 82.5% of patients had a BNIPIS ≤ 3, with 50% achieving a BNIPIS 1. Recurrence was identified in 37.3% of those patients[VSP3] that experienced initial improvement, at [VSP4] a median of 44 months after surgery. Left sided neurovascular contact (p=0.035) and arterial hypertension (p=0.012) were factors associated with recurrence. On a multivariate analysis, hypertension remained independently associated with recurrence (p=0.035).
Conclusion: Microvascular decompression is a valuable resource for managing refractory trigeminal neuralgia. Factors associated with recurrence are poorly understood. Arterial hypertension, a potentially modifiable risk factor, might be a recurrence predictor, possibly by modulating local vascular phenomena. Better understanding of the pathophysiology involved can provide physicians means to overcome this incapacitating disease.
Methods: We performed a retrospective analysis of the classical trigeminal neuralgia cases submitted to microvascular decompression in our center between 2003 and 2019. 57 patients were identified and pre-op clinical and imagiological characteristics, surgical findings, complications and pain control – both immediate and long-term – were described. Outcome was measured using the Barrow Neurological Institute Pain Intensity Score (BNIPIS).
Results: Mean age at procedure was 63.9 years, with a female predominance (66.7%). Most symptoms were in the V2 and V3 territory and the most common trigger identified was mastication. History of arterial hypertension was identified in 49.1%. Vascular contact at surgery was identified in almost all patients (97.6%). Regarding pain outcome results, at 6 months post-op, 80.7% of patients had a good outcome [VSP1] (defined as BNIPIS[VSP2] ≤ 3). This result was maintained at 12 months, with 78.9% of patients having a good outcome. At long follow-up (median 77 months), 82.5% of patients had a BNIPIS ≤ 3, with 50% achieving a BNIPIS 1. Recurrence was identified in 37.3% of those patients[VSP3] that experienced initial improvement, at [VSP4] a median of 44 months after surgery. Left sided neurovascular contact (p=0.035) and arterial hypertension (p=0.012) were factors associated with recurrence. On a multivariate analysis, hypertension remained independently associated with recurrence (p=0.035).
Conclusion: Microvascular decompression is a valuable resource for managing refractory trigeminal neuralgia. Factors associated with recurrence are poorly understood. Arterial hypertension, a potentially modifiable risk factor, might be a recurrence predictor, possibly by modulating local vascular phenomena. Better understanding of the pathophysiology involved can provide physicians means to overcome this incapacitating disease.
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