Outcome of Surgical Treatments of Chronic Pain Caused by Trigeminal Neuropathy.

Autor: Basha AKMM; Department of Neurosurgery, Ain Shams University, Cairo, Egypt. Electronic address: ahmedbasha@med.asu.edu.eg., Simry HAM; Department of Neurosurgery, Ain Shams University, Cairo, Egypt., Abdelbar AE; Department of Neurosurgery, Ain Shams University, Cairo, Egypt., Sabry H; Department of Neurosurgery, Ain Shams University, Cairo, Egypt., Raslan AM; Department of Neurosurgery, Oregon Health and Science University, Oregon, Portland, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2023 Feb; Vol. 170, pp. e57-e69. Date of Electronic Publication: 2022 Oct 20.
DOI: 10.1016/j.wneu.2022.10.057
Abstrakt: Background: Trigeminal neuropathy represents a subset of several facial pain syndromes that are difficult to diagnose and treat. Although many surgical modalities are available, outcomes remain suboptimal. The aim of this study is to present our experience in management of trigeminal neuropathy with a focus on the effectiveness and long-term efficacy of the different surgical procedures.
Methods: A single-center retrospective cohort study was conducted from December 2012 until February 2020.
Results: Twenty-eight patients (19 females, 9 males) were included in this study. They had 40 surgical interventions. At last follow-up, 1 patient (33.3%) treated by spinal cord stimulation (SCS) had no pain recurrence and 2 patients (66.6%) had their devices removed because of therapeutic failure. Median time to pain recurrence after SCS was 19.5 months (interquartile range [IQR], 29.79 months). Six patients were treated with peripheral nerve stimulation (PNS). At last follow-up, 2 patients had satisfactory pain relief, whereas half of the patients had no improvement. For the 17 patients treated with computed tomography-guided trigeminal tractotomy/nucleotomy, true failure occurred 7 times in 6 patients. Median time to pain recurrence was 5.6 months (IQR, 6.2). Of the 6 patients treated with caudalis DREZ, 3 (50%) had satisfactory pain relief for >1 year and the median time to pain recurrence was 3.9 months (IQR, 29.53).
Conclusions: Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. The long-term efficacy of available interventions does not meet patients' satisfaction. More organized prospective studies with longer follow-up are needed to define the patient population best served by each surgical modality.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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