Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors
Introduction: Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognosti...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | Spanish |
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Elsevier España
2023-11-01
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| Series: | Neurología |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0213485321000712 |
| _version_ | 1797633280340656128 |
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| author | L. Amaya Pascasio B. De La Casa-Fages E. Esteban de Antonio F. Grandas R. García-Leal F. Ruiz Juretschke |
| author_facet | L. Amaya Pascasio B. De La Casa-Fages E. Esteban de Antonio F. Grandas R. García-Leal F. Ruiz Juretschke |
| author_sort | L. Amaya Pascasio |
| collection | DOAJ |
| description | Introduction: Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognostic factors in a series of patients with trigeminal neuralgia treated by microvascular decompression. Methods: A retrospective observational study of 152 consecutive patients operated by microvascular decompression with at least six months of follow-up. The surgical results, including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period were reviewed. Binary regression analysis was performed to identify factors associated with a good long-term outcome. Results: A total of 152 patients with a mean age of 60 years and a mean follow-up of 43 months were included. At the final follow-up visit, 83% of the patients had achieved significant relief of the pain and 63% could reduce the absolute drug doses by 50% or more. The most frequent complications were wound infection (4.5%) and CSF fistula (7%). Being over 70 years of age and having paroxysmal pain were associated with a long-term pain relief. Conclusions: Our results support the notion that microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. A multidisciplinary approach with an early referral to a neurosurgical unit many be beneficial in patients who are refractory to pharmacological treatment. Resumen: Introducción: La descompresión microvascular se considera el tratamiento quirúrgico etiológico más eficaz de la neuralgia clásica del trigémino, dirigido a aliviar la compresión neurovascular identificada hasta en un 95% de casos. Este estudio tiene como objetivo analizar los resultados quirúrgicos y la evolución a largo plazo de una serie de pacientes con neuralgia del trigémino tratados mediante descompresión microvascular, así como identificar factores pronósticos. Métodos: Estudio observacional retrospectivo de 152 pacientes consecutivos sometidos a descompresión microvascular y con un seguimiento posquirúrgico mínimo de seis meses. Analizamos los resultados quirúrgicos, clasificando el grado de dolor según la escala del Instituto Neurológico de Barrow, las complicaciones y el tratamiento médico requerido durante el período de seguimiento. Realizamos un análisis de regresión binaria para identificar factores asociados con un buen resultado a largo plazo. Resultados: Incluimos 152 pacientes con una edad media de 60 años y un seguimiento medio de 43 meses. En la última visita de seguimiento, el 83% de los pacientes había logrado un alivio significativo del dolor y el 63% pudo reducir la dosis absoluta de fármacos para la neuralgia en un 50% o más. Las complicaciones más frecuentes fueron infección de la herida (4,5%) y fístula de LCR (7%). La edad superior a 70 años y el dolor de predominio paroxístico se asociaron con un mejor pronóstico. Conclusiones: Nuestros resultados apoyan que la descompresión microvascular es una terapia efectiva y segura en pacientes con neuralgia del trigémino. La cirugía temprana puede ser beneficiosa en pacientes refractarios al tratamiento farmacológico. |
| first_indexed | 2024-03-11T11:51:52Z |
| format | Article |
| id | doaj.art-623089529d03463aa7df458f0c649a26 |
| institution | Directory Open Access Journal |
| issn | 0213-4853 |
| language | Spanish |
| last_indexed | 2024-03-11T11:51:52Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier España |
| record_format | Article |
| series | Neurología |
| spelling | doaj.art-623089529d03463aa7df458f0c649a262023-11-09T04:11:19ZspaElsevier EspañaNeurología0213-48532023-11-01389625634Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factorsL. Amaya Pascasio0B. De La Casa-Fages1E. Esteban de Antonio2F. Grandas3R. García-Leal4F. Ruiz Juretschke5Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Corresponding author.Neurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, SpainNeurology Department, Hospital General Universitario Gregorio Marañon, Madrid, SpainNeurology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Neurosciences Area, Instituto Investigacion Sanitaria Gregorio Marañon, Madrid, SpainNeurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, SpainNeurosurgery Department, Hospital General Universitario Gregorio Marañon, Madrid, SpainIntroduction: Microvascular decompression is considered to be the most effective and only etiological surgical treatment for classical trigeminal neuralgia, relieving the neurovascular compression found in up to 95% of cases. This study aims to report the long-term outcomes and to identify prognostic factors in a series of patients with trigeminal neuralgia treated by microvascular decompression. Methods: A retrospective observational study of 152 consecutive patients operated by microvascular decompression with at least six months of follow-up. The surgical results, including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period were reviewed. Binary regression analysis was performed to identify factors associated with a good long-term outcome. Results: A total of 152 patients with a mean age of 60 years and a mean follow-up of 43 months were included. At the final follow-up visit, 83% of the patients had achieved significant relief of the pain and 63% could reduce the absolute drug doses by 50% or more. The most frequent complications were wound infection (4.5%) and CSF fistula (7%). Being over 70 years of age and having paroxysmal pain were associated with a long-term pain relief. Conclusions: Our results support the notion that microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. A multidisciplinary approach with an early referral to a neurosurgical unit many be beneficial in patients who are refractory to pharmacological treatment. Resumen: Introducción: La descompresión microvascular se considera el tratamiento quirúrgico etiológico más eficaz de la neuralgia clásica del trigémino, dirigido a aliviar la compresión neurovascular identificada hasta en un 95% de casos. Este estudio tiene como objetivo analizar los resultados quirúrgicos y la evolución a largo plazo de una serie de pacientes con neuralgia del trigémino tratados mediante descompresión microvascular, así como identificar factores pronósticos. Métodos: Estudio observacional retrospectivo de 152 pacientes consecutivos sometidos a descompresión microvascular y con un seguimiento posquirúrgico mínimo de seis meses. Analizamos los resultados quirúrgicos, clasificando el grado de dolor según la escala del Instituto Neurológico de Barrow, las complicaciones y el tratamiento médico requerido durante el período de seguimiento. Realizamos un análisis de regresión binaria para identificar factores asociados con un buen resultado a largo plazo. Resultados: Incluimos 152 pacientes con una edad media de 60 años y un seguimiento medio de 43 meses. En la última visita de seguimiento, el 83% de los pacientes había logrado un alivio significativo del dolor y el 63% pudo reducir la dosis absoluta de fármacos para la neuralgia en un 50% o más. Las complicaciones más frecuentes fueron infección de la herida (4,5%) y fístula de LCR (7%). La edad superior a 70 años y el dolor de predominio paroxístico se asociaron con un mejor pronóstico. Conclusiones: Nuestros resultados apoyan que la descompresión microvascular es una terapia efectiva y segura en pacientes con neuralgia del trigémino. La cirugía temprana puede ser beneficiosa en pacientes refractarios al tratamiento farmacológico.http://www.sciencedirect.com/science/article/pii/S0213485321000712Neuralgia del trigémino refractariaCompresión neurovascularCirugía de neuralgia del trigémino |
| spellingShingle | L. Amaya Pascasio B. De La Casa-Fages E. Esteban de Antonio F. Grandas R. García-Leal F. Ruiz Juretschke Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors Neurología Neuralgia del trigémino refractaria Compresión neurovascular Cirugía de neuralgia del trigémino |
| title | Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors |
| title_full | Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors |
| title_fullStr | Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors |
| title_full_unstemmed | Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors |
| title_short | Microvascular decompression for trigeminal neuralgia: A retrospective analysis of long-term outcomes and prognostic factors |
| title_sort | microvascular decompression for trigeminal neuralgia a retrospective analysis of long term outcomes and prognostic factors |
| topic | Neuralgia del trigémino refractaria Compresión neurovascular Cirugía de neuralgia del trigémino |
| url | http://www.sciencedirect.com/science/article/pii/S0213485321000712 |
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