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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Microvascular decompression for trigeminal neuralgia: preliminary results and an open invitation to join a european multicenter retrospective study

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  • Ehab Shiban - Klinikum rechts der Isar TU München , München, Deutschland
  • Bawarjan Schatlo - Neurosurgery Department, University Hospital of Göttingen, Germany, Göttingen, Deutschland
  • Freyschlag Christian - Neurosurgery Department, University Hospital of Innsbruck, Austria, Innsbruck, Austria
  • Rohde Veit - Neurosurgery Department, University Hospital of Göttingen, Germany, Göttingen, Deutschland
  • Thomé Claudius - Neurosurgery Department, University Hospital of Innsbruck, Austria, Innsbruck, Austria
  • Pedro Da Cunha - Serviço de Neurocirurgia, Centro Hospitalar Universitário de Coimbra, Portugal, Coimbra, Portugal
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Jens Lehmberg - Klinikum rechts der Isar TU München , München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.06.05

doi: 10.3205/17dgnc398, urn:nbn:de:0183-17dgnc3989

Published: June 9, 2017

© 2017 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

Objectives: Treatment of all patients with classic trigeminal neuralgia (TN) begins with drug therapy. The gold standard remains carbamazepine. However, the efficacy of carbamazepine is compromised by its adverse effects. Furthermore, after long-term follow-up (5 – 16 years) 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 will be performed. The following factors will be analyzed as possible risk factors for treatment failure: 1) Duration of symptoms 2) Low/high volume centers 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. With a study power of 80%, 688 patients will be needed. Primary outcome is pain-free patients at last follow up.

Results: For now 265 patients from 4 institutions have been analysed. Follow up data was obtained form 186 (73%). 122 patients were male (47.7%); mean age was 64 years. Mean duration of symptoms until surgery was 49.53 months (4,1 years).From 155 patients with available imaging data 115 (74.2%) had a visible conflict on the MRI. 64% of patients were pain free at last follow up. Facial hyposthesia was the most common complication and was seen in 9.4% of patients. There were no mortalities.

Conclusion: Microvascular decompression for trigeminal neuralgia is a safe and effective treatment modality. More institutions are invited to join our european wide effort.