TY - JOUR

T1 - Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia

T2 - A prospective systematic study using independent assessors

AU - Heinskou, Tone Bruvik

AU - Rochat, Per

AU - Maarbjerg, Stine

AU - Wolfram, Frauke

AU - Brennum, Jannick

AU - Olesen, Jes

AU - Bendtsen, Lars

PY - 2019

Y1 - 2019

N2 - Introduction: There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods: Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results: Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16–16.26), p = 0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12–59.52), p = 0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration. Conclusion: Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.

AB - Introduction: There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods: Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results: Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16–16.26), p = 0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12–59.52), p = 0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration. Conclusion: Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.

KW - Facial pain

KW - morphological changes

KW - neurosurgery

KW - neurovascular contact

KW - predictive factors

U2 - 10.1177/0333102418783294

DO - 10.1177/0333102418783294

M3 - Journal article

C2 - 29896973

AN - SCOPUS:85049044281

VL - 39

SP - 197

EP - 208

JO - Cephalalgia

JF - Cephalalgia

SN - 0800-1952

IS - 2

ER -