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Clinical outcome after microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis

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Abstract

Microvascular decompression (MVD) is considered an effective treatment for trigeminal neuralgia (TN). However, the anatomical and clinical variables associated with a better outcome are not fully examined. The authors performed a systematic review and meta-analysis of the literature investigating the immediate and long-term clinical results of MVD for TN, and the impact of the anatomical features of the neurovascular conflict on the outcome. The systematic search of three databases was performed for studies published between January 1990 and November 2021. PRISMA guidelines were followed. Random-effects meta-analysis was used to pool the analyzed outcomes, and random-effect meta-regression was used to examine the association between the effect size and potential confounders. A funnel plot followed by Egger’s linear regression was used to test publication bias. A total of 9 studies were included in this analysis, including 2102 patients with trigeminal neuralgia. The immediate post-operative rate of BNI I was 82.9%, whereas surgical failure (BNI IV-V) was reported in approximately 2.6% of patients. CSF leak was the most common postoperative complication (2.4%). The rate of BNI I at last follow up was 64.7% (p < 0.01), showing a significant negative correlation after multiple meta-regression with the rate of patients with isolated venous conflict (p < 0.01). On the other hand, the evidence of an arterial conflict proved is positive association with a favorable outcome (p < 0.01). At the last follow-up, BNI IV-V was reported in 19.2% (95% CI 8.9–29.5%, p < 0.01, I2 = 97.3%). This meta-analysis confirms the safety and efficacy of MVD for TN. The occurrence of serious postoperative complications is very low. The long-term outcome is associated with the type of vascular structure involved, being pure venous conflict associated with a higher risk of surgical failure. These findings should be considered when planning surgery for patients with TN.

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References

  1. Amaya Pascasio L, De La Casa-Fages B, Esteban de Antonio E, Grandas F, García-Leal R, Ruiz Juretschke F (2021) Microvascular decompression for trigeminal neuralgia: a retrospective analysis of long-term outcomes and prognostic factors. Neurologia. https://doi.org/10.1016/j.nrl.2021.03.009

    Article  PubMed  Google Scholar 

  2. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD, Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083. https://doi.org/10.1056/NEJM199604253341701

    Article  PubMed  Google Scholar 

  3. Barker FG II, Jannetta PJ, Babu RP, Pomonis S, Bissonette DJ, Jho HD (1996) Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. J Neurosurg 84:818–825. https://doi.org/10.3171/jns.1996.84.5.0818

    Article  PubMed  Google Scholar 

  4. Brown JA, Coursaget C, Preul MC, Sangvai D (1999) Mercury water and cauterizing stones: Nicolas Andre and tic douloureux. J Neurosurg 90:977–981. https://doi.org/10.3171/jns.1999.90.5.0977

    Article  PubMed  CAS  Google Scholar 

  5. Burchiel KJ (2003) A new classification for facial pain. Neurosurgery 53:1164–1166; discussion 1166–1167. https://doi.org/10.1227/01.NEU.0000088806.11659.D8

  6. Burchiel KJ (2016) Trigeminal neuralgia: new evidence for origins and surgical treatment. Neurosurgery 63:52–55. https://doi.org/10.1227/NEU.0000000000001276

    Article  PubMed  Google Scholar 

  7. Burchiel KJ, Clarke H, Haglund M, Loeser JD (1988) Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:35–38. https://doi.org/10.3171/jns.1988.69.1.0035

    Article  PubMed  CAS  Google Scholar 

  8. Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede R-D, Zakrzewska JM, Nurmikko T (2016) Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology 87:220–228. https://doi.org/10.1212/WNL.0000000000002840

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM (2008) AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol 15:1013–1028. https://doi.org/10.1111/j.1468-1331.2008.02185.x

    Article  PubMed  CAS  Google Scholar 

  10. Dandy WE (1934) Concerning the cause of trigeminal neuralgia. Am J Surg 24:447–455. https://doi.org/10.1016/S0002-9610(34)90403-7

    Article  Google Scholar 

  11. DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials. https://doi.org/10.1016/j.cct.2015.09.002

    Article  PubMed  PubMed Central  Google Scholar 

  12. Devor M, Amir R, Rappaport ZH (2002) Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 18:4–13

    Article  PubMed  Google Scholar 

  13. Devor M, Govrin-Lippmann R, Rappaport ZH (2002) Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg 96:532–543

    Article  PubMed  Google Scholar 

  14. Duan Y, Sweet J, Munyon C, Miller J (2015) Degree of distal trigeminal nerve atrophy predicts outcome after microvascular decompression for Type 1a trigeminal neuralgia. J Neurosurg 123:1512–1518. https://doi.org/10.3171/2014.12.JNS142086

    Article  PubMed  Google Scholar 

  15. Dumot C, Brinzeu A, Berthiller J, Sindou M (2017) Trigeminal neuralgia due to venous neurovascular conflicts: outcome microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien) 159:237–249. https://doi.org/10.1007/s00701-016-2994-y

    Article  PubMed  Google Scholar 

  16. Gardner WJ, Miklos MV (1959) Response of trigeminal neuralgia to decompression of senso1. Hong JM1. Hong JM, Chung C-S, Bang OY, Yong SW, Joo IS, Huh K (2009). J Am Med Assoc 170:1773–1776. https://doi.org/10.1001/jama.1959.03010150017004

    Article  PubMed  CAS  Google Scholar 

  17. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327:557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  Google Scholar 

  18. Inoue T, Shitara S, Goto Y, Prasetya M, Fukushima T (2021) Petrosal vein involvement in neurovascular conflict in trigeminal neuralgia: surgical technique and clinical outcomes. Oper Neurosurg (Hagerstown, Md) 20:E264–E271. https://doi.org/10.1093/ons/opaa422

    Article  Google Scholar 

  19. Jannetta PJ (1976) Microsurgical approach to the trigeminal nerve for tic douloureux. In: Pain-Its Neurosurgical Management. Karger Publishers, pp 180–200

  20. Kitt CA, Gruber K, Davis M, Woolf CJ, Levine JD (2000) Trigeminal neuralgia: opportunities for research and treatment. Pain 85:3–7

    Article  PubMed  CAS  Google Scholar 

  21. Ko AL, Lee A, Raslan AM, Ozpinar A, McCartney S, Burchiel KJ (2015) Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression. J Neurosurg 123:1519–1527

    Article  PubMed  Google Scholar 

  22. Li ST, Pan Q, Liu N, Shen F, Liu Z, Guan Y, Sindou M, Burchiel KJ (2004) Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression. Surg Neurol 62:400–405. https://doi.org/10.1016/j.surneu.2004.02.028

    Article  PubMed  Google Scholar 

  23. Love S, Coakham HB (2001) Trigeminal neuralgia: pathology and pathogenesis. Brain 124:2347–2360

    Article  PubMed  CAS  Google Scholar 

  24. Masuoka J, Matsushima T, Inoue K, Nakahara Y, Takase Y, Kawashima M (2015) Outcome of microvascular decompression for trigeminal neuralgia treated with the stitched sling retraction technique. Neurosurg Rev 38:361–5; discussion 365. https://doi.org/10.1007/s10143-015-0607-5

  25. Matsushima T, Huynh-Le P, Miyazono M (2004) Trigeminal neuralgia caused by venous compression. Neurosurgery 55:334–339. https://doi.org/10.1227/01.neu.0000129552.87291.87

    Article  PubMed  Google Scholar 

  26. Miller JP, Magill ST, Acar F, Burchiel KJ (2009) Predictors of long-term success after microvascular decompression for trigeminal neuralgia: clinical article. J Neurosurg 110:620–626. https://doi.org/10.3171/2008.9.17660

    Article  PubMed  Google Scholar 

  27. Mizobuchi Y, Nagahiro S, Kondo A, Arita K, Date I, Fujii Y, Fujimaki T, Hanaya R, Hasegawa M, Hatayama T, Inoue T, Kasuya H, Kobayashi M, Kohmura E, Matsushima T, Masuoka J, Morita A, Nishizawa S, Okayama Y, Shigeno T, Shimano H, Takeshima H, Yamakami I (2021) Microvascular decompression for trigeminal neuralgia: a prospective, multicenter study. Neurosurgery 89:557–564. https://doi.org/10.1093/neuros/nyab229

    Article  PubMed  Google Scholar 

  28. Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement (reprinted from annals of internal medicine). Phys Ther 89:873–880. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  Google Scholar 

  29. Nunta-Aree S, Patiwech K, Sitthinamsuwan B (2018) Microvascular decompression for treatment of trigeminal neuralgia: factors that predict complete pain relief and study of efficacy and safety in older patients. World Neurosurg 110:e979–e988. https://doi.org/10.1016/j.wneu.2017.11.147

    Article  PubMed  Google Scholar 

  30. Rose FC (1999) Trigeminal neuralgia. Arch Neurol 56:1163–1164. https://doi.org/10.1001/archneur.56.9.1163

    Article  PubMed  CAS  Google Scholar 

  31. Sindou M, Leston J, Decullier E, Chapuis F (2007) Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg 107:1144–1153. https://doi.org/10.3171/JNS-07/12/1144

    Article  PubMed  Google Scholar 

  32. Sterne JAC, Harbord RM (2004) Funnel plots in meta-analysis stata J 4:127–141

    Google Scholar 

  33. Szapiro J Jr, Sindou M (1986) Micro-surgical treatment of trigeminal neuralgia. Results and prognostic factors of the microvascular decompression. Neurochirurgie 32:103–121

    PubMed  Google Scholar 

  34. Tyler-Kabara EC, Kassam AB, Horowitz MH, Urgo L, Hadjipanayis C, Levy EI, Chang Y-F (2002) Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression. J Neurosurg 96:527–531. https://doi.org/10.3171/jns.2002.96.3.0527

    Article  PubMed  Google Scholar 

  35. Wang DD, Raygor KP, Cage TA, Ward MM, Barbaro NM, Chang EF, Westcott S, Barbaro NM, Chang EF (2018) Prospective comparison of long-term pain relief rates after frst-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J Neurosurg 128:68–77. https://doi.org/10.3171/2016.9.JNS16149

    Article  PubMed  Google Scholar 

  36. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2013) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hosp Res Inst 1–4. https://doi.org/10.2307/632432

  37. Zakrzewska JM, Akram H (2011) Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev 9

  38. Zakrzewska JM, 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 - commentary. Acta Neurochir (Wien) 148:1245. https://doi.org/10.1007/s00701-006-0809-2

    Article  Google Scholar 

  39. Zhang H, Lei D, You C, Mao B-Y, Wu B, Fang Y (2013) The long-term outcome predictors of pure microvascular decompression for primary trigeminal neuralgia. World Neurosurg 79:756–762. https://doi.org/10.1016/j.wneu.2012.01.040

    Article  PubMed  Google Scholar 

  40. The International Classification of Headache Disorders, 3rd edition Copyright. https://doi.org/10.1177/0333102417738202

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Acknowledgements

We thank Prof. Beth De Felici for the English revision.

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  1. Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy

    Davide Tiziano Di Carlo, Nicola Benedetto & Paolo Perrini

  2. Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Davide Tiziano Di Carlo & Paolo Perrini

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DTDC and PP contributed to the study conception and design. DTDC and NB performed a literature search, collection, screening, and analysis. DTDC and NB interpreted the results and assessed the risk of bias. DTDC wrote the draft of the manuscript. All authors critically reviewed, commented, and approved the final manuscript.

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Correspondence to Davide Tiziano Di Carlo.

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Di Carlo, D., Benedetto, N. & Perrini, P. Clinical outcome after microvascular decompression for trigeminal neuralgia: a systematic review and meta-analysis. Neurosurg Rev 46, 8 (2023). https://doi.org/10.1007/s10143-022-01922-0

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