Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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A Clinical Analysis of Secondary Surgery in Trigeminal Neuralgia Patients Who Failed Prior Treatment

  • Kang, Il Ho (Department of Neurosurgery, Kyung Hee University College of Medicine) ;
  • Park, Bong Jin (Department of Neurosurgery, Kyung Hee University College of Medicine) ;
  • Park, Chang Kyu (Department of Neurosurgery, Kyung Hee University College of Medicine) ;
  • Malla, Hridayesh Pratap. (Department of Medicine, Graduate School, Kyung Hee University) ;
  • Lee, Sung Ho (Department of Neurosurgery, Kyung Hee University College of Medicine) ;
  • Rhee, Bong Arm (Department of Neurosurgery, Kyung Hee University College of Medicine)
  • Received : 2016.05.17
  • Accepted : 2016.09.26
  • Published : 2016.11.01
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Abstract

Objective : Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. Methods : We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. Results : Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. Conclusion : Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.

Keywords

References

  1. Abdennebi B, Guenane L : Technical considerations and outcome assessment in retrogasserian balloon compression for treatment of trigeminal neuralgia. Series of 901 patients. Surg Neurol Int 5 : 118, 2014 https://doi.org/10.4103/2152-7806.137838
  2. Amador N, Pollock BE : Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia. J Neurosurg 108 : 916-920, 2008 https://doi.org/10.3171/JNS/2008/108/5/0916
  3. Bakker NA, Van Dijk JM, Immenga S, Wagemakers M, Metzemaekers JD : Repeat microvascular decompression for recurrent idiopathic trigeminal neuralgia. J Neurosurg 121 : 936-939, 2014 https://doi.org/10.3171/2014.7.JNS132667
  4. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Jho HD : Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia. Neurosurgery 40 : 39-45, 1997
  5. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD : The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334 : 1077-1083, 1996 https://doi.org/10.1056/NEJM199604253341701
  6. Bederson JB, Wilson CB : Evaluation of microvascular decompression and partial sensory rhizotomy in 252 cases of trigeminal neuralgia. J Neurosurg 71 : 359-367, 1989 https://doi.org/10.3171/jns.1989.71.3.0359
  7. Bender M, Pradilla G, Batra S, See A, Bhutiani N, James C, et al. : Effectiveness of repeat glycerol rhizotomy in treating recurrent trigeminal neuralgia. Neurosurgery 70 : 1125-1133; discussion 1133-1134, 2012 https://doi.org/10.1227/NEU.0b013e31823f5eb6
  8. Blomstedt PC, Bergenheim AT : Technical difficulties and perioperative complications of retrogasserian glycerol rhizotomy for trigeminal neuralgia. Stereotact Funct Neurosurg 79 : 168-181, 2002 https://doi.org/10.1159/000070830
  9. Capelle HH, Brandis A, Tschan CA, Krauss JK : Treatment of recurrent trigeminal neuralgia due to Teflon granuloma. J Headache Pain 11 : 339- 344, 2010 https://doi.org/10.1007/s10194-010-0213-4
  10. Cheng JS, Lim DA, Chang EF, Barbaro NM : A review of percutaneous treatments for trigeminal neuralgia. Neurosurgery 10 Suppl 1 : 25-33; discussion 33, 2014
  11. Cho DY, Chang CG, Wang YC, Wang FH, Shen CC, Yang DY : Repeat operations in failed microvascular decompression for trigeminal neuralgia. Neurosurgery 35 : 665-669; discussion 669-670, 1994 https://doi.org/10.1227/00006123-199410000-00012
  12. Czepko R, Kwinta B, Libionka W, Pietraszko W : [Direct and late outcome in trigeminal neuralgia treated by means of microvascular decompression in cerebellopontine angle]. Przegl Lek 60 : 621-624, 2003
  13. Dvorak T, Finn A, Price LL, Mignano JE, Fitzek MM, Wu JK, et al. : Retreatment of trigeminal neuralgia with Gamma Knife radiosurgery : is there an appropriate cumulative dose? Clinical article. J Neurosurg 111 : 359-364, 2009 https://doi.org/10.3171/2008.11.JNS08770
  14. Gu W, Zhao W : Microvascular decompression for recurrent trigeminal neuralgia. J Clin Neurosci 21 : 1549-1553, 2014 https://doi.org/10.1016/j.jocn.2013.11.042
  15. Gusmao S, Oliveira M, Tazinaffo U, Honey CR : Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy. Technical note. J Neurosurg 99 : 785-786, 2003 https://doi.org/10.3171/jns.2003.99.4.0785
  16. Han I, Shin D, Chang J, Kim K, Chang J, Huh R, et al. : Effect of various surgical modalities in recurrent or persistent trigeminal neuralgia. Stereotact Funct Neurosurg 88 : 156-162, 2010 https://doi.org/10.1159/000303530
  17. Harries AM, Mitchell RD : Percutaneous glycerol rhizotomy for trigeminal neuralgia : safety and efficacy of repeat procedures. Br J Neurosurg 25 : 268-272, 2011 https://doi.org/10.3109/02688697.2011.558946
  18. Henson CF, Goldman HW, Rosenwasser RH, Downes MB, Bednarz G, Pequignot EC, et al. : Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia : an analysis of patients treated at one institution. Int J Radiat Oncol Biol Phys 63 : 82-90, 2005 https://doi.org/10.1016/j.ijrobp.2005.01.033
  19. Jannetta PJ : Trigeminal neuralgia and hemifacial spasm--etiology and definitive treatment. Trans Am Neurol Assoc 100 : 89-91, 1975
  20. Jannetta PJ, Bissonette DJ : Management of the failed patient with trigeminal neuralgia. Clin Neurosurg 32 : 334-347, 1985
  21. Kabatas S, Albayrak SB, Cansever T, Hepgul KT : Microvascular decompression as a surgical management for trigeminal neuralgia : a critical review of the literature. Neurol India 57 : 134-138, 2009 https://doi.org/10.4103/0028-3886.51279
  22. Kondziolka D, Zorro O, Lobato-Polo J, Kano H, Flannery TJ, Flickinger JC, et al. : Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 112 : 758-765, 2010 https://doi.org/10.3171/2009.7.JNS09694
  23. Kureshi SA, Wilkins RH : Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm : surgical findings and therapeutic implications. Neurosurgery 43 : 1111-1117, 1998 https://doi.org/10.1097/00006123-199811000-00061
  24. Lee JK, Choi HJ, Ko HC, Choi SK, Lim YJ : Long term outcomes of gamma knife radiosurgery for typical trigeminal neuralgia-minimum 5-year follow-up. J Korean Neurosurg Soc 51 : 276-280, 2012 https://doi.org/10.3340/jkns.2012.51.5.276
  25. Lee SH, Park BJ, Shin HS, Park CK, Rhee BA, Lim YJ : Prognostic ability of intraoperative electromyographic monitoring during microvascular decompression for hemifacial spasm to predict lateral spread response outcome. J Neurosurg 2016 Apr 22 [Epub]. http://dx.doi.org/10.3171/2016.1.JNS151782.
  26. Meyer B, Lehmberg J : Treatment options for refractory trigeminal neuralgia. World Neurosurg 77 : 275-276, 2012 https://doi.org/10.1016/j.wneu.2011.08.001
  27. Murali R, Rovit RL : Are peripheral neurectomies of value in the treatment of trigeminal neuralgia? An analysis of new cases and cases involving previous radiofrequency gasserian thermocoagulation. J Neurosurg 85 : 435-437, 1996 https://doi.org/10.3171/jns.1996.85.3.0435
  28. Noorani I, Lodge A, Vajramani G, Sparrow O : Comparing percutaneous treatments of trigeminal neuralgia : 19 years of experience in a single centre. Stereotact Funct Neurosurg 94 : 75-85, 2016 https://doi.org/10.1159/000445077
  29. Pollock BE : Percutaneous retrogasserian glycerol rhizotomy for patients with idiopathic trigeminal neuralgia : a prospective analysis of factors related to pain relief. J Neurosurg 102 : 223-228, 2005 https://doi.org/10.3171/jns.2005.102.2.0223
  30. Pollock BE, Stein KJ : Surgical management of trigeminal neuralgia patients with recurrent or persistent pain despite three or more prior operations. World Neurosurg 73 : 523-528, 2010 https://doi.org/10.1016/j.wneu.2010.01.027
  31. Rath SA, Klein HJ, Richter HP : Findings and long-term results of subsequent operations after failed microvascular decompression for trigeminal neuralgia. Neurosurgery 39 : 933-938; discussion 938-940, 1996
  32. Sanchez-Mejia RO, Limbo M, Cheng JS, Camara J, Ward MM, Barbaro NM : Recurrent or refractory trigeminal neuralgia after microvascular decompression, radiofrequency ablation, or radiosurgery. Neurosurg Focus 18 : e12, 2005
  33. Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, et al. : Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia : comparison of results following microvascular decompression. J Neurosurg 96 : 527-531, 2002 https://doi.org/10.3171/jns.2002.96.3.0527
  34. Walchenbach R, Voormolen JH : Surgical treatment for trigeminal neuralgia. BMJ 313 : 1027-1028, 1996 https://doi.org/10.1136/bmj.313.7064.1027
  35. Weidmann MJ : Trigeminal neuralgia. Surgical treatment by microvascular decompression of the trigeminal nerve root. Med J Aust 2 : 628-630, 1979
  36. Wilkins RH : Surgical therapy of neuralgia : vascular decompression procedures. Semin Neurol 8 : 280-285, 1988 https://doi.org/10.1055/s-2008-1041390
  37. Wilson CB, Yorke C, Prioleau G : Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 132 : 481-487, 1980
  38. Xu-Hui W, Chun Z, Guang-Jian S, Min-Hui X, Guang-Xin C, Yong-Wen Z, et al. : Long-term outcomes of percutaneous retrogasserian glycerol rhizotomy in 3370 patients with trigeminal neuralgia. Turk Neurosurg 21 : 48-52, 2011
  39. Yang DB, Jiang DY, Chen HC, Wang ZM : Second microvascular decompression for trigeminal neuralgia in recurrent cases after microvascular decompression. J Craniofac Surg 26 : 491-494, 2015 https://doi.org/10.1097/SCS.0000000000001523
  40. Zakrzewska JM : Surgical management of trigeminal neuralgia. Br Dent J 170 : 61-62, 1991 https://doi.org/10.1038/sj.bdj.4807418
  41. Zakrzewska JM, Lopez BC : Trigeminal neuralgia. Clin Evid (15) : 1827-1835, 2006
  42. Ziccardi VB, Braun TW, Ochs MW : Trigeminal neuralgia : review of etiologies and treatments. Compendium 14 : 1256, 1258-1262; quiz 1264, 1993
  43. Zuniga JR : Surgical management of trigeminal neuropathic pain. Atlas Oral Maxillofac Surg Clin North Am 9 : 59-75, 2001 https://doi.org/10.1016/S1061-3315(18)30018-0

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