Artikel
Preoperative duration of symptoms is the most influential risk factor for treatment failure following microvascular decompression for trigeminal neuralgia
Die Präoperative Dauer von Symptomen ist der wesentliche Risikofaktor für Therapieversagen nach mikrovaskulärer Dekompression bei Trigeminusneuralgie
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Veröffentlicht: | 8. Mai 2019 |
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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. Aim of this study is to assess the clinical outcome following the surgical treatment of TN and to 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. At final follow up, a telephone interview for patients satisfaction was conducted.
Results: 970 patients from 20 European institutions were analyzed. Follow up data was obtained form 881 (90.8%). 414 patients were male (43%) mean age was 61 years. Mean duration of symptoms until surgery was 70.6 months (5.8 years). Of the 858 patients with available imaging data, 615 (71.6%) had a visible conflict on the MRI. 62.2% 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=0.012). Telephone interviews were conducted with 699 (72%) patients. Of those 599 (85%) were satisfied with surgery and 459 (65%) would have preferred earlier surgery.
Conclusion: Microvascular decompression for trigeminal neuralgia is a safe and effective treatment method and should probably be done early on. A randomized controlled study comparing MVD to best medical management is warranted.