Microvascular Decompression versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Experience
Autor: | Jennifer Noeller, Scott C. Seaman, Luyuan Li, Patrick W. Hitchon, Bilge Dundar, Girish Bathla, Mark C. Smith |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Pain relief Microvascular decompression medicine.disease digestive system diseases Radiosurgery Surgery 03 medical and health sciences 0302 clinical medicine Refractory Trigeminal neuralgia 030220 oncology & carcinogenesis parasitic diseases cardiovascular system medicine In patient Neurology (clinical) Favorable outcome Single institution business 030217 neurology & neurosurgery |
Zdroj: | World Neurosurgery. 143:e400-e408 |
ISSN: | 1878-8750 |
DOI: | 10.1016/j.wneu.2020.07.161 |
Popis: | Objective Microvascular decompression (MVD) is the standard surgical procedure for patients with medically refractory trigeminal neuralgia (TN). Stereotactic radiosurgery (SRS) has gained increasing popularity as a less invasive technique. We report our institution’s outcome in the surgical treatment of TN (MVD vs. SRS), taking patient’s age and gender into consideration. Methods We retrospectively reviewed a prospectively collected database of patients undergoing MVD or SRS for type 1 idiopathic TN between 2004 and 2019 at the University of Iowa. Standardized data collection focused on preoperative clinical characteristics and postoperative outcomes including the Barrow Neurological Institute (BNI) Pain Intensity Score. Results A total of 111 patients underwent MVD and 103 patients underwent SRS for TN. Patients were younger in the MVD (median, 60 years) than SRS (median, 72 years) group. More females (58%) than males (42%) had TN. Multivariate ordinal regression analysis showed that an outcome of BNI score I–II (P = 0.365) and III (P = 0.736) can be achieved with either MVD or SRS; however, BNI score IV (P = 0.031) and V (P = 0.022) were more associated with SRS. Six percent of patients in the MVD group and 26% in the SRS group developed pain recurrence and required a second operation. Nine of 10 patients who underwent MVD after failed SRS had complete pain relief. Conclusions Factoring in patients’ age and gender, both MVD and SRS can achieve a favorable outcome for medically refractory TN, although BNI scores of IV and V were more common with SRS. |
Databáze: | OpenAIRE |
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