gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Preoperative symptom duration is the most influential risk factor for treatment failure following microvascular decompression for trigeminal neuralgia – a European multi-centre study with 1101 patients

Die präoperative Symptomdauer ist der einflussreichste Risikofaktor für das Behandlungsversagen nach mikrovaskulärer Dekompression bei Trigeminusneuralgie – eine europäische multizentrische Studie mit 1101 Patienten

Meeting Abstract

  • presenting/speaker Ehab Shiban - Universitätsklinikum Augsburg, Klinik für Neurochirurgie, Augsburg, Deutschland
  • Artemis Pauline Fritsche - München Klinik Bogenhausen, Neurochirurgie, München, Deutschland
  • Bawarjan Schatlo - Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Silvia Hernández-Durán - Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Christian F. Freyschlag - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria
  • Claudius Thomé - Medizinische Universität Innsbruck, Klinik für Neurochirurgie, Innsbruck, Austria
  • Pedro da Cunha - University of Coimbra, Neurosurgery, Coimbra, Portugal
  • Marcos Barbosa - University of Coimbra, Neurosurgery, Coimbra, Portugal
  • Stefanie Maurer - Vivantes Klinikum Neukölln, Neurochirurgie, Berlin, Deutschland
  • Andreas Jödicke - Vivantes Klinikum Neukölln, Neurochirurgie, Berlin, Deutschland
  • Marisa Gandia-Gonzalez - University Hospital La Paz, Neurosurgery, Madrid, Spain
  • Andreas Demetriades - University of Edinburgh, Department of Neurosurgery, Edinburgh, United Kingdom
  • Ammar Natalwala - University of Edinburgh, Department of Neurosurgery, Edinburgh, United Kingdom
  • Lennart Barthel - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Vicente Vanaclocha - University of Valencia, Department of Neurosurgery, Valencia, Spain
  • Guillermo Blasco - La Princesa University Hospital, Department of Neurosurgery, Madrid, Spain
  • Luciano Mastronardi - San Filippo Neri Hospital, Department of Neurosurgery, Rom, Italy
  • Florian Ringel - Universitätsmedizin Mainz, Neurochirurgie, Mainz, Deutschland
  • Naureen Keric - Universitätsmedizin Mainz, Neurochirurgie, Mainz, Deutschland
  • Malte Ottenhausen - Universitätsmedizin Mainz, Neurochirurgie, Mainz, Deutschland
  • Pablo González-López - General Hospital University of Alicante, Department of Neurosurgery, Alicante, Spain
  • Ruth Lau Rodriguez - Bellvitge University Hospital Barcelona, Department of Neurosurgery, Barcelona, Spain
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Dominik Seggewiß - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Fernando Ruiz Juretschke - General Hospital University Gregorio Marañón, Department of Neurosurgery, Madrid, Spain
  • Roberto Garcia Leal - General Hospital University Gregorio Marañón, Department of Neurosurgery, Madrid, Spain
  • Luis Ley - Ramon y Cajal University Hospital, Department of Neurosurgery, Madrid, Spain
  • Santiago Rocha Romero - Hospital Virgen del Rocío, Department of Neurosurgery, Sevilla, Spain
  • Walter Stummer - Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
  • Christian Ewelt - Universitätsklinikum Münster, Neurochirurgie, Münster, Deutschland
  • Martin Bolcha - Jan-Evangelista-Purkyně-University, Neurosurgery, Ústí nad Labem, Czech Republic
  • Martin Sameš - Jan-Evangelista-Purkyně-University, Neurosurgery, Ústí nad Labem, Czech Republic
  • Andrii Naboichenko - National Academy of Medical Sciences of Ukraine, Medical Clinic IV Endocrinology, Kiev, Ukraine
  • Alessandro Moiraghi - Genfer Universitätsspitäler, Neurochirurgie, Genf, Switzerland
  • Philippe Bijlenga - Genfer Universitätsspitäler, Neurochirurgie, Genf, Switzerland
  • Paula Alvarez Bonillo - Mútua Terrassa University Hospital, Department of Neurosurgery, Barcelona, Spain
  • Marcel Garcia Bach - Mútua Terrassa University Hospital, Department of Neurosurgery, Barcelona, Spain
  • Bernhard Meyer - Technische Universität München, Klinik für Neurochirurgie, München, Deutschland
  • Jens Lehmberg - München Klinik Bogenhausen, Neurochirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV025

doi: 10.3205/20dgnc029, urn:nbn:de:0183-20dgnc0293

Published: June 26, 2020

© 2020 Shiban et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The gold standard for the treatment of classic trigeminal neuralgia (TN) is carbamazepine. However, the efficacy of carbamazepine is compromised by its adverse effects. Furthermore, after long-term follow-up only 22% of participants still find carbamazepine effective. Aim of this study is to assess the clinical outcome following the surgical treatment of TN and find potential factors for treatment failure.

Methods: A multicenter retrospective data analysis was performed. Primary outcome was the rate of pain free patients at last follow up. The following factors were analyzed as possible risk factors for treatment failure:

1.
Duration of symptoms
2.
surgical experience
3.
Technique: Neurovascular interposition or neurovascular transposition
4.
Number of affected nerve branches
5.
Presence or absence of neurovascular conflict on MRI
6.
Indication for surgery: medical treatment failure (persisting pain) or intolerable adverse effects of the medication.

At final follow up a telephone interview for patients satisfaction was conducted.

Results: 1101 patients from 23 European institutions were analysed. Follow up data was obtained form 1012 (91.9%). 450 patients were male (41%) mean age was 61 years. Mean duration of symptoms until surgery was 70.6 months (5.8 years). From 989 patients with available imaging data 700 (71%) had a visible conflict on the MRI. 68.2% of patients were pain free at last follow up. Facial hypoesthesia was the most common complication and was seen in 18.4% of patients. There were no mortalities. Regression analysis revealed than only preoperative duration of symptoms correlated with treatment failure (p=0.0012). Telephone interview was conducted with 830 (75%) patients. Of Those 693 (84%) were satisfied with surgery and 554 (67%) would have preferred earlier surgery.

Conclusion: Microvascular decompression for trigeminal neuralgia is a safe and effective treatment method and should probably be done early one. A randomized controlled study comparing MVD to best medical management is warranted.