Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Prospective Comparison of Redo Microvascular Decompression and Percutaneous Balloon Compression as Primary Surgery for Recurrent Trigeminal Neuralgia

  • Chen, Jing-nan (Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University) ;
  • Yu, Wen-hua (Department of Neurosurgery, The First People's Hospital of Hangzhou) ;
  • Du, Hang-gen (Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University) ;
  • Jiang, Li (Department of Neurosurgery, The First People's Hospital of Hangzhou) ;
  • Dong, Xiao-qiao (Department of Neurosurgery, The First People's Hospital of Hangzhou) ;
  • Cao, Jie (Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University)
  • Received : 2017.06.24
  • Accepted : 2017.11.24
  • Published : 2018.11.01
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Abstract

Objective : To prospectively compare facial pain outcomes for patients having either a repeat microvascular decompression (MVD) or percutaneous balloon compression (PBC) as their surgery for trigeminal neuralgia (TN) recurrence. Methods : Prospective cohort study of 110 patients with TN recurrence who had either redo MVD (n=68) or PBC (n=42) from July 2010 until September 2016. The mean follow-up was 45.6 months. Results : After redo MVD, 65 patients (95.6%) experienced immediate relief of pain. After PBC, 34 patients (81%) were immediately relieved of their neuralgia. After 1 month, the clinical effect of redo MVD was better than PBC (p<0.01). Patients who had redo MVD more commonly were pain free off medications (93.4% at 1 year, 78.2% at 4 years) compared with the PBC patients (85.1% at 1 year, 59.3% at 4 years). However, mean length of stay was longer (p>0.05). Patients after PBC who occurred developed herpes simplex (35.7%), facial numbness (76.2%), and annoying dysesthesia (21.4%) more frequently compared with patients after redo MVD who occurred developed herpes simplex (14.7%), facial numbness (8.8%), and hypoesthesia (5.9%) (p<0.05). The symptoms recurred respectively in 15 patients (22.1%) and 19 patients (45.2%) after redo MVD and PBC within the entire 6-year follow-up period. Conclusion : For the patients with TN recurrence, redo MVD was a more effective procedure than PBC. The cure rate and immediate relief of pain were better, and the incidence of complications was lower.

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References

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