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Clinical Research
Available online 14 November 2024
Review of therapeutic failures of microvascular decompression in trigeminal neuralgia at a tertiary hospital
Revisión de los fracasos terapéuticos de la descompresión microvascular en la neuralgia del trigémino en un hospital terciario
Emilio González Martínez
Corresponding author
, Giancarlo Mattos-Piaggio, David Santamarta Gómez
Servicio de Neurocirugía, Hospital Universitario de León, León, Spain
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Tables (4)
Table 1. Clinical and epidemiological data.
Table 2. Intraoperative data.
Table 3. Epidemiological data and follow-up according to response to MVD.
Table 4. Hypothetical causal data for MVD failure with a description of intraoperative findings in repeat surgery patients.
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Abstract
Introduction

Microvascular decompression (MVD) is a non-ablative technique aimed at relieving pain in trigeminal neuralgia (TN) by resolving a neurovascular conflict. Despite reported high success rates, a significant percentage of patients experience therapeutic failure.

Methods

Retrospective observational study of patients with suspected TN undergoing MVD was performed with the goal of identifying factors contributing to the persistence and recurrence of pain.

Results

In the present study, 31 patients undergoing 38 MVD procedures for TN were included (7 patients underwent reoperation after the failure of the initial operation). The mean age was 58.5 years with a male predominance (58.1%). The mean duration of pain was 6.4 years, mainly affecting branches V2 and V3 (46.7%). The most frequently described neurovascular conflict was with the superior cerebellar artery (54.8%), predominantly resolved with Teflon (75.9%).

In our case series, MVD achieved pain control in 80.6% of patients at one-year post-intervention and 61.3% at the end of the follow-up period. Twelve patients experienced MVD failure: 5 cases of persistent pain and 7 cases of pain recurrence. A detailed analysis of these failures identified misdiagnosis as the reason of persistent pain in 4 patients, while inadequate surgical technique could be the cause of pain recurrence in 6 patients.

Conclusion

In our study, therapeutic failures could mainly be attributed to two factors: misdiagnosis or the use of inappropriate materials. These factors should be considered when optimizing the management of DMV in patients with NT.

Keywords:
Trigeminal neuralgia
Microvascular decompression
Neurovascular conflict
Outcome
Surgical treatment
Resumen
Introducción

La descompresión microvascular (DMV) es una técnica no ablativa dirigida a aliviar el dolor en la neuralgia del trigémino (NT) mediante la resolución del conflicto neurovascular. A pesar de haberse descrito altas cifras de éxito, un significativo porcentaje de pacientes sufren fracaso terapéutico.

Métodos

Estudio observacional retrospectivo de pacientes con sospecha de NT y sometidos a DMV con el objetivo de identificar los factores que determinaron la persistencia y recurrencia del dolor.

Resultados

En el presente estudio fueron incluidos 31 pacientes sometidos a 38 procedimientos de DMV por NT (7 pacientes fueron reintervenidos tras el fracaso de la primera operación). La edad media fue 58,5 años con predominio del sexo masculino (58,1%). El tiempo medio de evolución del dolor era 6,4 años afectando principalmente ramas V2 y V3 (46.7%). El conflicto neurovascular más frecuentemente descrito fue con la arteria cerebelosa superior (54.8%), y fue resuelto generalmente con teflón (75,9%).

En nuestra serie de casos, la DMV obtuvo control del dolor en el 80.6% al año de la intervención, y el 61,3% al final periodo de seguimiento. Doce pacientes presentaron fracaso de la DMV: 5 casos de dolor persistente, y 7 casos de recurrencia del dolor. Un análisis detallado de estos fracasos determinó un diagnóstico erróneo como causa de dolor persistente en 4 pacientes, mientras que la interposición de materiales inadecuados para la resolución del conflicto neurovascular pudo ser el motivo de la recurrencia del dolor en otros 6 pacientes.

Conclusión

En nuestro estudio, los fracasos terapéuticos pudieron ser atribuidos a dos factores principalmente: diagnóstico erróneo y la interposición de un material inadecuado. Estos factores deben considerarse en la optimización del manejo de la DMV en paciente con NT.

Palabras clave:
Neuralgia del trigémino
Descompresión microvascular
Conflicto neurovascular
Pronóstico
Técnica quirúrgica

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