Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study.

Autor: Altamirano JM; Research Direction, Mexico General Hospital 'Dr. Eduardo Liceaga', Mexico City, Mexico.; Neurosurgery Department, Hospital Angeles Clínica Londres, Mexico City, Mexico., Jimenez-Olvera M; Pain management Unit, Mexico General Hospital 'Dr. Eduardo Liceaga', Mexico City, Mexico., Moreno-Jimenez S; Radiosurgery Unit, Department of Neurosurgery, Neurological Center, National Institute of Neurology and Neurosurgery 'Dr. Manuel Velasco Suarez', Mexico City, Mexico., Gutierrez-Aceves GA; Radiosurgery Unit, Department of Neurosurgery, Neurological Center, National Institute of Neurology and Neurosurgery 'Dr. Manuel Velasco Suarez', Mexico City, Mexico., Velasco-Campos F; Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital 'Dr. Eduardo Liceaga', Mexico City, Mexico., Navarro-Olvera JL; Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital 'Dr. Eduardo Liceaga', Mexico City, Mexico., Carrillo-Ruiz JD; Research Direction, Mexico General Hospital 'Dr. Eduardo Liceaga', Mexico City, Mexico.; Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital 'Dr. Eduardo Liceaga', Mexico City, Mexico.; Neuroscience Coordination, Psychology Faculty, Mexico Anahuac University, México City, Mexico.
Jazyk: angličtina
Zdroj: Pain practice : the official journal of World Institute of Pain [Pain Pract] 2024 Mar; Vol. 24 (3), pp. 514-524. Date of Electronic Publication: 2023 Dec 09.
DOI: 10.1111/papr.13327
Abstrakt: Background: Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse.
Objective: This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN.
Methods: To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively.
Results: MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group.
Conclusion: Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.
(© 2023 World Institute of Pain.)
Databáze: MEDLINE
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