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Arachnoiditis as an outcome factor for microvascular decompression in classical trigeminal neuralgia

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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A Correction to this article was published on 20 November 2019

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Abstract

Background

Neurovascular conflict is considered a key element of classical trigeminal neuralgia (TN) and consequently, microvascular decompression (MVD) is an effective treatment. Nevertheless, failures of MVD are described by many authors. In some patients, the arachnoid membranes surrounding the trigeminal nerve and neighbouring vessels may be thickened and adhesive. Here we analyse the impact of such focal arachnoiditis on outcome after MVD for TN.

Methods

A cohort of prospectively followed patients after their MVD was reviewed for intraoperative, imaging and clinical data if findings of arachnoiditis during MVD were described. Long-term outcome assessment was the main endpoint.

Results

We reviewed data from 395 MVD procedures, performed for TN from 2001 to 2014. Intraoperative evidence of focal arachnoiditis, as described by the surgeon, has been noted in 51 patients (13%). In 35 (68.6%), neuralgia was typical and in the other 17 (31.4%) it was atypical.

As expected by definition, neurovascular conflict was found in 49 interventions (96%); it was predominantly arterial in 27 (52.9%). Accompanying arachnoiditis was encountered: mild in 20 interventions (39.2%), severe in 31 (60.8%).

A successful result (BNI I or II) was achieved in 29 patients (56.9%). The other 22 patients (43.1%) had persistence or recurrence of pain. Overall KM probability of being pain free at 15 years was 72%.

Conclusions

Intraoperative finding of arachnoiditis during MVD for classical trigeminal neuralgia is associated with poorer outcome than that of classical trigeminal neuralgia in general. This is particularly true for low grades of conflict.

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Change history

  • 20 November 2019

    Figure 3 corrected.

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Authors and Affiliations

  1. Catholic University of Sacred Heart, Rome, Italy

    Edoardo Mazzucchi

  2. University de Lyon 1, Lyon, France

    Andrei Brinzeu & Marc Sindou

  3. University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania

    Andrei Brinzeu & Marc Sindou

  4. Service de Neurochirugie Fonctionelle, 59 Boulevard Pinel, 69003, Lyon, France

    Andrei Brinzeu

Authors
  1. Edoardo Mazzucchi
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  2. Andrei Brinzeu
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  3. Marc Sindou
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Correspondence to Andrei Brinzeu.

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This study was approved by the ethics committee of the “Hopital Neurologique de Lyon”.

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All patients signed an informed consent form with the surgeon prior to the procedure.

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Mazzucchi, E., Brinzeu, A. & Sindou, M. Arachnoiditis as an outcome factor for microvascular decompression in classical trigeminal neuralgia. Acta Neurochir 161, 1589–1598 (2019). https://doi.org/10.1007/s00701-019-03981-7

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  • DOI: https://doi.org/10.1007/s00701-019-03981-7

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