Microvascular decompression versus percutaneous procedures for typical trigeminal neuralgia: personal experience

Area of Science:

• Neurosurgery
• Pain Management
• Neurology

Background:

• Trigeminal neuralgia is a debilitating neuropathic facial pain condition.
• Several treatment modalities exist, including percutaneous microcompression (PMC), radiofrequency thermocoagulation (RFT), and microvascular decompression (MVD).
• Comparative long-term efficacy and safety data for these procedures are crucial for clinical decision-making.

Purpose of the Study:

• To compare the long-term effectiveness and safety of PMC, RFT, and MVD in patients with typical trigeminal neuralgia.
• To evaluate pain relief rates and the incidence of adverse events across the different treatment groups.

Main Methods:

• A retrospective study involving 127 patients with typical trigeminal neuralgia.
• Patients were treated with either PMC (n=74), RFT (n=33), or MVD (n=20).
• Outcomes including pain relief and complications were assessed at hospital discharge and at a mean 24-month follow-up.

Main Results:

• At discharge, pain relief was achieved in 93.2% (PMC), 81.8% (RFT), and 85% (MVD).
• At 24 months, sustained pain relief was observed in 57.2% (PMC), 57.6% (RFT), and 75% (MVD).
• Adverse events included dysesthesia (6.7% PMC, 24.2% RFT) and masticatory dysfunction (10% PMC); MVD had one case of hypoacusia and transient IV nerve palsy.

Conclusions:

• Microvascular decompression (MVD) demonstrated superior long-term pain relief for trigeminal neuralgia compared to PMC and RFT.
• Percutaneous microcompression (PMC) and radiofrequency thermocoagulation (RFT) offer immediate pain relief but with a higher incidence of specific side effects and lower long-term efficacy.
• The choice of treatment should consider the trade-off between short-term efficacy, long-term durability, and potential complications.