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Long-term outcomes of microvascular decompression and Gamma Knife surgery for trigeminal neuralgia: a retrospective comparison study

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Abstract

Background

There is still no clear guideline for surgical treatment for patients with medically refractory trigeminal neuralgia (TN). When it comes to which surgical treatment to choose, microvascular decompression (MVD) or Gamma Knife surgery (GKS), we should know the long-term outcome of each treatment.

Methods

We analyzed 179 patients undergoing MVD and 52 patients undergoing GKS followed for 1 year or longer. We evaluated the patient’s neurological status including pain relief, complications and recurrence. Results were assessed with Barrow Neurological Institute (BNI) pain intensity and facial numbness scores. Overall outcomes were compared between the two groups based on pain relief and complications.

Results

BNI pain intensity and facial numbness scores at the final visit were significantly lower in the MVD group than in the GKS group (P < 0.001, P = 0.04, respectively). Overall outcomes were superior following MVD than following GKS (P < 0.001). Following whichever treatment, there were initially high rates of pain-free status “without medication”: 96.6% in the MVD group and 96.2% in the GKS group. However, 6.1% in the MVD group and 51.9% in the GKS group fell into a “with medication” state within median periods of 1.83 and 3.92 years, respectively (P < 0.001). Kaplan-Meier analysis revealed that pain recurred more often and later in the GKS group than in the MVD group (P < 0.001).

Conclusions

Considering the long-term outcomes, MVD should be chosen as the initial surgical treatment for patients with medically refractory TN.

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Acknowledgments

We thank Ms. Satomi Fujimura and Ms. Lori Radcliffe for assistance with data collection and English language editing.

Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan

    Takuro Inoue, Hisao Hirai, Ayako Shima, Fumio Suzuki & Masayuki Matsuda

  2. Department of Cardiology, Subarukai Kotoh Kinen Hospital, Higashiohmi-shi, Shiga, Japan

    Masayuki Yamaji

  3. Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA

    Takanori Fukushima

Authors
  1. Takuro Inoue
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  2. Hisao Hirai
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  3. Ayako Shima
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  4. Fumio Suzuki
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  5. Masayuki Yamaji
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  6. Takanori Fukushima
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  7. Masayuki Matsuda
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Correspondence to Takuro Inoue.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Inoue, T., Hirai, H., Shima, A. et al. Long-term outcomes of microvascular decompression and Gamma Knife surgery for trigeminal neuralgia: a retrospective comparison study. Acta Neurochir 159, 2127–2135 (2017). https://doi.org/10.1007/s00701-017-3325-7

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  • DOI: https://doi.org/10.1007/s00701-017-3325-7

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