gms | German Medical Science

Objective: Trigeminal neuralgia (TN) is a severe pain condition and the most common facial neuralgia. While microvascular decompression (MVD) yields good results, percutaneous thermocoagulation (PT) of the ganglion Gasseri presents a less invasive alternative. The aim of this study was to evaluate outcome and complication-rates of both procedures.

Methods: The records of all TN-patients undergoing MVD or PT between 01/2007 and 09/2017 were reviewed concerning efficacy and the complication rate of both treatments. Results were also assessed in regard to patient’s age.

Results: 79 patients underwent 83 MVDs and 41 patients received 69 PTs. Mean age was 64.9 years, 61 were female. In age group 1 (<50y; 15 pts.) 93.3% received MVD and 6.7% PT; in group 2 (51-60y; 25 pts.) 84% MVD and 16% PT; in group 3 (61-70y; 34 pts.) 73.5% MVD and 26.5% PT; and in group 4 (>71y; 46 pts.) 41.3% MVD and 58.7% PT. The mean follow-up was 11.7 (±21.0) months for MVD- and 13 (±13.6) for PT. In 5 MVD cases PT was performed as a secondary treatment, while 24 patients received MVD following PT. The Barrow pain score (BNS) at last follow-up showed grade I and II (no or occasional pain without medication) in 82.2% of MVD and 48.7% of PT pts.; grade III (some pain controlled with medication) in 17.7% of MVD and 29.3% of PT pts. and grade IV (some pain not controlled with medication) in 2.5% of MVD and in 17% of PT pts. Complications included facial hypoesthesia (14 after MVD and 33 after PT), CSF-fistula (4 MVD), loss or deterioration of hearing in 2 pts. in each group; other postoperative complications (pulmonary embolism, pneumonia, wound healing problem) occurred in 7 MVD and 2 PT pts. One patient died of cardiac infarction after MVD. No difference was found in the overall complication rate in older pts. Significantly lower pain recurrence rate was seen in 26.6% of pts. 6.8 (±9.4) months post MVD compared to 75.6% of pts. 5.3 (±6.2) months post PT (P<0.0001). The recurrence rate after MVD was higher in pts. <50y compared to all other age groups, while the recurrence rate after PT did not differ between age groups.

Conclusion: In this patient series MVD proved to be an excellent treatment option independent of the patient’s age. Though PT is an effective procedure, time to pain recurrence is shorter and the favorable outcome (BNS I and II) rarer. Hence MVD should be the treatment of choice even in elderly patients and PT should be regarded as an alternative in selected cases when MVD is not possible.