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Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients.
Acta Neurochir (Wien) 2006; 148(12):1235-45; discussion 1245AN

Abstract

BACKGROUND

Few publications on primary Trigeminal Neuralgia treated by Micro-Vascular Decompression (MVD) report large series, with long-term follow-up, using Kaplan-Meier (K-M) analysis. None was specifically directed to the comparative study of MVD effectiveness on Trigeminal Neuralgia with typical (i.e., with paroxysmal pain only) and atypical features (i.e., with association of a permanent background of pain).

METHOD

The authors report a series of 362 patients having clearcut vascular compression and treated with pure MVD - i.e., without any additional cut or coagulation of the adjacent root fibers. Follow-up was 1 to 18 y (8 y on average, with a median of 7.2 y). Results were considered overall, then separately for patients with typical (237 (65.5%)) and atypical (125 (34.5%)) clinical presentation.

FINDINGS

One year after operation, (294 (81.2%) of patients were totally-free - of paroxysmal pain, and also of permanent background pain - and not needing any medication) 13 (3.6%) still had a background of pain but without the need for medication which 55 patients (15.2%), treatment had failed. At latest review (8 y on average) the corresponding rates were 80, 4.9 and 15.1%, respectively. Kaplan-Meier analysis estimated the probability of total cure at 15 y to be 73.4%. There was no difference in the cure rate between patients with typical and atypical features at one year: 81 and 81.16%, respectively. The probability of cure at 15 y was identical for the two clinical presentations.

CONCLUSIONS

Pure MVD offers patients affected by Trigeminal Neuralgia due to vascular compression a long-lasting cure in three-fourths of the cases. Both typical and atypical presentations respond well to MVD, view in contrast to the classical view that an atypical presentation has an adverse effect on outcome after surgery.

Authors+Show Affiliations

Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer Hospital, University of Lyon, France. marc.sindou@chu-lyon.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

16804643

Citation

Sindou, M, et al. "Micro-vascular Decompression for Primary Trigeminal Neuralgia (typical or Atypical). Long-term Effectiveness On Pain; Prospective Study With Survival Analysis in a Consecutive Series of 362 Patients." Acta Neurochirurgica, vol. 148, no. 12, 2006, pp. 1235-45; discussion 1245.
Sindou M, Leston J, Howeidy T, et al. Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien). 2006;148(12):1235-45; discussion 1245.
Sindou, M., Leston, J., Howeidy, T., Decullier, E., & Chapuis, F. (2006). Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochirurgica, 148(12), pp. 1235-45; discussion 1245.
Sindou M, et al. Micro-vascular Decompression for Primary Trigeminal Neuralgia (typical or Atypical). Long-term Effectiveness On Pain; Prospective Study With Survival Analysis in a Consecutive Series of 362 Patients. Acta Neurochir (Wien). 2006;148(12):1235-45; discussion 1245. PubMed PMID: 16804643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Micro-vascular decompression for primary Trigeminal Neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. AU - Sindou,M, AU - Leston,J, AU - Howeidy,T, AU - Decullier,E, AU - Chapuis,F, Y1 - 2006/09/18/ PY - 2005/11/16/received PY - 2006/04/25/accepted PY - 2006/6/29/pubmed PY - 2007/9/12/medline PY - 2006/6/29/entrez SP - 1235-45; discussion 1245 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 148 IS - 12 N2 - BACKGROUND: Few publications on primary Trigeminal Neuralgia treated by Micro-Vascular Decompression (MVD) report large series, with long-term follow-up, using Kaplan-Meier (K-M) analysis. None was specifically directed to the comparative study of MVD effectiveness on Trigeminal Neuralgia with typical (i.e., with paroxysmal pain only) and atypical features (i.e., with association of a permanent background of pain). METHOD: The authors report a series of 362 patients having clearcut vascular compression and treated with pure MVD - i.e., without any additional cut or coagulation of the adjacent root fibers. Follow-up was 1 to 18 y (8 y on average, with a median of 7.2 y). Results were considered overall, then separately for patients with typical (237 (65.5%)) and atypical (125 (34.5%)) clinical presentation. FINDINGS: One year after operation, (294 (81.2%) of patients were totally-free - of paroxysmal pain, and also of permanent background pain - and not needing any medication) 13 (3.6%) still had a background of pain but without the need for medication which 55 patients (15.2%), treatment had failed. At latest review (8 y on average) the corresponding rates were 80, 4.9 and 15.1%, respectively. Kaplan-Meier analysis estimated the probability of total cure at 15 y to be 73.4%. There was no difference in the cure rate between patients with typical and atypical features at one year: 81 and 81.16%, respectively. The probability of cure at 15 y was identical for the two clinical presentations. CONCLUSIONS: Pure MVD offers patients affected by Trigeminal Neuralgia due to vascular compression a long-lasting cure in three-fourths of the cases. Both typical and atypical presentations respond well to MVD, view in contrast to the classical view that an atypical presentation has an adverse effect on outcome after surgery. SN - 0001-6268 UR - https://www.unboundmedicine.com/medline/citation/16804643/Micro_vascular_decompression_for_primary_Trigeminal_Neuralgia__typical_or_atypical___Long_term_effectiveness_on_pain L2 - https://dx.doi.org/10.1007/s00701-006-0809-2 DB - PRIME DP - Unbound Medicine ER -